1. Dual stent deployment for the treatment plaque protrusion after carotid artery stenting for the pseudo-occlusion of the internal carotid artery Department of Neurosurgery, Showa university Fujigaoka Hospital Tomoaki Terada M.D., Ph.D., Yoichi Imaizumi M.D., Ph.D, Jo Matuzaki M.D. A 75-year-old male with symptomatic right carotid artery pseudo-occlusion was treated with carotid artery stenting (CAS) under triple balloon occlusion for the distal internal carotid artery, external carotid artery and common carotid artery. Angiogram after stent (Precise 8x40m) deployment demonstrated massive plaque protrusion through the stent strut. The plaque protrusion was confirmed by intravascular ultrasound (IVUS) and it caused nearly 40% stenosis inside of the stent. Under triple balloon occlusion, carotid Wallstent 10x31mm was deployed inside of the Precise stent. Post dilatation was added at the portion of the plaque protrusion and at the distal end of the stent where stent coning was shown. The plaque was sealed by the second stent and stenosis was well dilatated successfully. Dual stent deployment under strict embolic protection was effective for the plaque protrusion after CAS for the pseudo-occlusion of the internal carotid artery.

2. Rt-CCAG

3. Procedure (Triple Balloon Occlusion)

4. Post PTA/Stenting (Plaque Protrusion)

5. Stent in Stent Procedure and Post Dilataion

6. Final Angiogram