A Case of Folding Deformation of PROTÉGÉ Stent during Carotid Artery Stenting with Distal Embolic Protection

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Objective: A case of folding deformation of a PROTÉGÉ RX (PROTÉGÉ; eV3 Covidien, Irvine, CA, USA) stent during carotid artery stenting (CAS) with distal filter protection is reported. Folding deformation complicated retrieval of the filter device.

Case Presentation: A 67-year-old man was diagnosed with left asymptomatic cervical internal carotid artery stenosis, which gradually progressed despite medical treatment. The stenosis was long and eccentric, comprising soft plaque with partial calcification. CAS was performed under distal filter protection using a right brachial artery approach. After pre-dilation, a PROTÉGÉ 10-mm × 60-mm stent was placed from the internal carotid to common carotid artery. Since the stent was not sufficiently dilated even after postdilation, additional balloon angioplasty was attempted. However, the balloon was trapped by the stent strut and could not cross the lesion. Cone-beam CT showed stent folding deformation extending from the internal carotid to common carotid artery. The deformed part of the stent was dilated with stepwise balloon angioplasty from proximal to distal, and the filter device was eventually retrieved. The patient showed no new neurologic symptoms after the procedure and no infarction was noted on postprocedural MRI.

Conclusion: In performing CAS using PROTÉGÉ for long, eccentric stenosis with calcification, the risk of stent folding deformation should be carefully considered.