2025 Volume 47 Issue 2 Pages 99-104
Carotid artery stenting (CAS) is generally performed with proximal protection against soft plaques. In emergency operations, however, lesion crossing must be performed without protection. An 80-year-old man was admitted to our hospital with cerebral infarction caused by left internal carotid artery stenosis. Loss of consciousness and severe right hemiparesis were observed on admission. Magnetic resonance imaging (MRI) revealed worsening of the left internal carotid artery stenosis, and emergency stenting was performed. The stenosis included soft vulnerable plaques in the MRI. Preparation of protective devices is challenging in emergencies; therefore we performed Lesion crossing under proximal protection, using an occlusion balloon to avoid embolic complications. Postoperatively, the patient’s condition improved, and he recovered without cerebral infarction. This method was used in nine subsequent cases between April 2022 and May 2024 for vulnerable plaques in cases where it was difficult to prepare protective devices. In the outcomes of those 9 cases, postoperative diffusion-weighted imaging (DWI) was positive in one case (11%), and there was no symptomatic cerebral infarction in any of the nine cases. We consider this method as a secondary protection option to avoid embolic complications of vulnerable plaques, especially in emergency cases.
