Thrombosuction for procedural acute thrombosis during high-risk carotid angioplasty--a case report.

Carotid endarterectomy in the presence of an occluded contralateral artery is associated with a high risk of perioperative stroke. Carotid stenting with neuroprotection devices has emerged as a safe procedure for revascularization in this circumstance. We performed high-risk carotid angioplasty in a patient with a history of recurrent transient ischemic attacks and 90% stenosis of left internal carotid artery with other occluded cerebral vessels. The final follow-up angiogram revealed thrombotic obstruction of the stent without any evidence of vasospasm, stent deformation or dissection. Direct thrombosuction was performed with the guiding sheath. Multiple suction passes yielded complete restoration of vascular patency and intracranial flows. A control angiogram performed 10 days later revealed no residual stenosis or thrombus. Thrombosuction using a guiding sheath leads to rapid revascularization in a patient with acute carotid stent thrombosis.