Emergent rescue extracranial-intracranial bypass for acute carotid stent thrombosis– case report

Abstract Background Acute stent thrombosis is a rare adverse event following endovascular treatment of carotid artery. Experience on the topic is scarce making the therapeutic approach a clinical challenge. In cases of intraprocedural acute carotid stent thrombosis, thromboaspiration, thrombectomy, and thrombolysis have been used as successful modalities for achieving recanalization. Case presentation We describe a case of carotid artery dissection treated endovascularly and complicated by intraprocedural stent thrombosis which was ultimately managed by emergent extracranial-intracranial bypass with radial artery graft connecting the external carotid artery to ipsilateral middle cerebral artery. Conclusions Neurosurgical management may represent a rescue option for otherwise unmanageable acute carotid stent thrombosis.