Stent Retriever-Assisted Embolic Protection During Recanalization of Chronic Internal Carotid Artery Occlusion with Contralateral Carotid Stenosis: A Case Report.

摘要

BACKGROUND: Chronic internal carotid artery occlusion (CICAO) with contralateral stenosis confers high stroke risk, particularly when thrombocytopenia complicates dual antiplatelet therapy (DAPT). We report a single case of staged carotid revascularization in which a stent retriever was used as a temporary distal protection device during CICAO recanalization after hematologic optimization. CASE PRESENTATION: A 69-year-old woman with chronic hepatitis B-related thrombocytopenia (20-68 × 109/L) presented with progressive imbalance (NIHSS 3, mRS 2). Imaging revealed bilateral parieto-occipital infarcts, chronic left ICA occlusion, and severe right ICA stenosis (80% North American Symptomatic Carotid Endarterectomy Trial (NASCET)). After eltrombopag therapy increased platelet counts to >300 × 109/L, DAPT was initiated. Revascularization was performed in two stages: right ICA stenting with distal filter protection, followed 14 days later by left CICAO recanalization using a Catch Mini stent retriever (Balt, Montmorency, France) as temporary embolic protection and dual-stent reconstruction (proximal Wallstent (Boston Scientific, Marlborough, MA, USA) and distal braided Leo+ stent (Balt, Montmorency, France)). Both procedures were completed without periprocedural complications. At 6 months, CTA demonstrated distal re-occlusion of the cavernous (C4) segment; however, the patient remained clinically stable (NIHSS 0) without recurrent ischemic events. CONCLUSION: The stent retriever-assisted approach was technically feasible in this single carefully selected patient and may offer a solution to the inherent limitation of conventional embolic protection devices in CICAO recanalization; however, its protective efficacy cannot be established without post-procedural imaging, which was not obtained in this case.