Abstract
Carotid endarterectomy (CEA) is an effective stroke prevention strategy. However, carotid artery stenting (CAS) is widely performed as an alternative treatment because of its minimally invasive nature. Use of an embolic protection device (EPD) is essential during stenting to reduce surgical complications. Although these devices are designed such that they focus on the management of emboli traveling into the internal carotid artery, emboli traveling through the external carotid artery should also be considered, particularly in patients having severe arteriosclerosis with dangerous anastomosis. We report the case of a patient who developed postoperative cerebellar infarction following CAS for symptomatic stenosis. In this case, the patient demonstrated an anastomosis between the external carotid and vertebral artery that facilitated the transmission of emboli to the cerebellum. Collateral pathways and dangerous anastomosis must be considered prior to selecting surgical procedures.
