An asymptomatic 73-year-old man was scheduled for carotid stenting because of a progressive 90% stenosis of the right internal carotid artery. His risk factors included hypertension, previous smoking, and diabetes. He had no history of any major serious illnesses, and his left ventricular function was normal.
Preprocedural antithrombotic treatment consisted of aspirin and clopidogrel. Carotid access was accomplished through a No. 6 French sheath over a No. 4 French Berenstein (J & J Cordis, Miami, Florida) catheter. After sheath placement, heparin was administered, and a 5.0-mm Spider Filter (ev3Inc., Plymouth, Minnesota) was positioned. A self-expanding 8.0/40-mm Conformexx stent (C.R. Bard Inc., Murray Hill, New Jersey) was placed across the lesion, followed by postdilation at 6 atm with a 5.0/20-mm balloon. The Spider Filter was subsequently retrieved, showing no visible particles. The procedure was well tolerated by the patient, and the postprocedural neurologic examination was normal. On postprocedural diffusion-weighted magnetic resonance imaging (MRI) performed 16 hours after the procedure, however, a new focal lesion was detected (figure). Despite this cerebral ischemic event, the patient remained free of obvious neurologic symptoms.