Retrieval of Entrapped Embolic Protection Device during Carotid Artery Stenting: A Case Report.

Aim: This study aims to report a rare case of an embolization protection device (EPD) entrapment during Carotid Artery Stent (CAS) and to discuss the management strategy, including open surgery and concurrent carotid endarterectomy (CEA).

Case presentation: A 71-year-old female presented with left limb weakness and unclear speech following CAS. Imaging revealed a new cerebral infarction and right internal carotid artery stenosis. The patient underwent endovascular retrieval of the entrapped EPD, which failed, leading to an emergency open surgical procedure.

Results: The surgical approach involved a longitudinal incision along the anterior border of the right sternocleidomastoid muscle, followed by carotid artery exposure and temporal artery clamps application. The entrapped EPD and stent were successfully retrieved, and the thrombus was aspirated. Subsequent endarterectomy removed the stenotic plaque, and meticulous washing cleared the carotid arteries. Post-operative indocyanine green fluorescence angiography confirmed patency of the arteries, and the patient was discharged without new neurological symptoms after 11 days of hospitalization.

Conclusions: This case underscores the challenges in managing EPD entrapment during CAS and the necessity for a swift transition to open surgical intervention when endovascular techniques fail. The concurrent performance of CEA in such cases offers a comprehensive treatment strategy, highlighting the importance of a multidisciplinary approach in complex vascular interventions.