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Background <p>Carotid stent thrombosis (CST) is a rare but devastating complication after carotid artery stenting (CAS). However, treatment strategy for CST remains controversial.</p> Case presentation <p>Case 1 was a 66-year-old man treated with scheduled CAS using a dual-layer stent for symptomatic internal carotid artery stenosis and developed CST 2–5&#xa0;days after intervention, causing repeated transient ischemic attacks 2&#xa0;months later. Case 2 was a 69-year-old man initially treated with emergent CAS using a closed-cell stent for acute ischemic stroke and developed CST with minor stroke six months after CAS. Both patients had impaired cerebrovascular reserve (CVR) on single-photon emission computed tomography. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass was performed with no procedural complications, and ischemic stroke has not recurred for subsequent 2&#xa0;years and 4&#xa0;years, respectively.</p> Conclusion <p>STA-MCA bypass may be beneficial to CST with mild neurological symptoms and impaired CVR, which occurs in subacute to chronic phases after CAS: the bypass could reduce the risks of distal embolization, damage to carotid artery and stent, and reperfusion injury.</p>

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Superficial temporal artery-middle cerebral artery bypass for carotid stent thrombosis: two case reports and literature review

  • 期刊论文

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  • 发表日期：

    2025年3月11日

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  • Hideki Nakajima,
  • Takuro Tsuchiya,
  • Shigetoshi Shimizu,
  • Hidenori Suzuki

摘要

Background

Carotid stent thrombosis (CST) is a rare but devastating complication after carotid artery stenting (CAS). However, treatment strategy for CST remains controversial.

Case presentation

Case 1 was a 66-year-old man treated with scheduled CAS using a dual-layer stent for symptomatic internal carotid artery stenosis and developed CST 2–5 days after intervention, causing repeated transient ischemic attacks 2 months later. Case 2 was a 69-year-old man initially treated with emergent CAS using a closed-cell stent for acute ischemic stroke and developed CST with minor stroke six months after CAS. Both patients had impaired cerebrovascular reserve (CVR) on single-photon emission computed tomography. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass was performed with no procedural complications, and ischemic stroke has not recurred for subsequent 2 years and 4 years, respectively.

Conclusion

STA-MCA bypass may be beneficial to CST with mild neurological symptoms and impaired CVR, which occurs in subacute to chronic phases after CAS: the bypass could reduce the risks of distal embolization, damage to carotid artery and stent, and reperfusion injury.