Abstract 1122‐000078: C‐Guard Stent for the Treatment of Cervical Internal Carotid Artery Aneurysms: Report of 2 Cases

Introduction : C‐Guard carotid stent is a self‐expandable open cell stent covered with a double‐layer mesh which was developed for the treatment of internal carotid artery disease. Lower procedural and complications rates, as well as lower post‐operative infarctions are some advantages of this device. Nevertheless, the use of C‐Guard in the treatment of cervical internal carotid artery (ICA) aneurysms is scarce. Therefore, we present two cases in which the C‐Guard stent achieved complete angiographic occlusion at follow‐up. Methods : We identified two cases in which the C‐Guard carotid stent was used to treat symptomatic cervical ICA aneurysms. Angiographic follow‐up was performed. Results : Case 1: 47‐yo female presented left‐sided motor deficit. CT showed ischemic areas in the right hemisphere and CTA demonstrated an unruptured aneurysm in the C1 segment of the right ICA. The patient started dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. A 6mm x 40 mm C‐Guard carotid stent was deployed without complications. One‐year follow‐up CTA showed complete obliteration of the aneurysm with reconstruction of the ICA. Case 2: 38‐yo male presented decreased left visual acuity. CTA and DSA showed an unruptured aneurysm in the C1 segment of the ICA. The patient started DAPT with aspirin and clopidogrel. A 7mm x 30 mm C‐Guard carotid stent was deployed without complications. Three‐month follow‐up DSA showed complete obliteration of the aneurysm with adequate filling of distal vessels. Conclusions : C‐Guard stent is a potential alternative to conventional carotid stents in the treatment of cervical ICA aneurysms with high obliteration rates at follow‐up.

Repeated Cardiac Arrest Following Emergency Carotid Artery Stenting.- A Case Report.

Background: Due to carotid sinus response, blood pressure reduction and bradycardia during and after carotid stent implantation was reported frequently, in contrast, repeated cardiac arrest is rare but fatal unless the heart can be started quickly. Case introduction: A 61-year-old male presented with severe left hemiplegia, aphasia, central facial palsy and gaze. Emergency surgery under general anesthesia was finally scheduled in view of possible severe cerebral arterial stenosis. The patient underwent ipsilateral ICA stenting after balloon dilatation and was transferred to intensive care unit(ICU). His heart rate tended to decrease sharply and then cardiac arrest was noted on electrocardiograph(ECG) monitor. Emergency cardiopulmonary resuscitation(CPR) was started and repeated three times due to persistent symptoms. Coronary angiography was postponed for 15 days until neurological recovery. Multivessel disease with severe stenosis one of them was confirmed and percutaneous coronary intervention (PCI) was performed. The patient was discharged on the 20th day of admission with only slight neurological deficits. Conclusion: We tend to attribute the causes of repeated cardiac arrest in this case to carotid sinus response induced by stenting and serious coronary stenosis.

Unconventional Treatment of a Giant Coronary Aneurysm Presenting as St-Elevation Myocardial Infarction: A Case Report

Background The optimal treatment of aneurysmal or ectatic culprit vessels in the setting of acute myocardial infarction is still matter of debate, as revascularization with either percutaneous intervention or surgery is associated with low procedural success and poor outcomes. Case Summary We report the case of a 55-year-old male patient, admitted for inferior ST-elevation myocardial infarction, who underwent successful percutaneous implantation of a micro-mesh self-expanding nitinol carotid stent in a right coronary aneurysm with IVUS-measured diameter of 9 mm and massive thrombus apposition. Discussion The technical characteristics of the micro-mesh self-expanding nitinol carotid stent allow for adequate plaque coverage and good apposition even in large vessels, making this device particularly suitable for the treatment of coronary lesions with high thrombus burden, when severe coronary ectasia or aneurysms are present.