A Case of Carotid Artery Stenting after Aspiration of Thrombus and Unstable Plaque

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Objective: There is no established method for carotid artery stenting (CAS) for internal carotid artery stenosis with vulnerable plaque and thrombosis. We report a case in which CAS was performed by aspiration using the Penumbra system for thrombosis that increased in the subacute phase in symptomatic cervical internal carotid artery stenosis.

Case Presentations: A 59-year-old man with a history of lacunar infarction visited the emergency department with weakness in the right upper limb. He was admitted for cerebral infarction in the left corona radiata and basal ganglia. During the course, additional multiple cerebral infarctions developed in the left cerebral hemisphere. The patient was diagnosed with left internal carotid artery stenosis and underwent CAS. As mural thrombus increased compared with preoperative imaging, CAS was performed after thrombus aspiration using the Penumbra system. A large amount of plaque was observed in the aspirated blood.

Conclusion: Thrombus aspiration using the Penumbra system was effective as distal embolic protection during CAS for internal carotid artery stenosis with increased and shape-changing thrombus. The aspirated blood exhibited pathological findings of plaque tissue and thrombus.