Dislocation of a cerebral protection device component during carotid stenting: A case report of favorable outcome from conservative management after failure of retrieval

tINTRODUCTION: Cerebral-protection devices (CPDs) are a well-established system for reduction ofembolic risk in carotid artery angioplasty and stenting (CAS). Although rare, adverse events with CPDsare unpredictable and can be associated with serious outcomes and iatrogenic sequelae.PRESENTATION OF CASE: We describe the unique case of dislocation of a FilterWire EXTMfilter loop duringright CAS. On trying to recapture the CPD filter at the end of the procedure, the filter loop suddenlydetached from the guidewire and dislocated to the proximal middle cerebral artery. Attempted retrievalof the loop failed and the patient developed a transient neurological deficit caused by an acute ischemicinfarction in the lenticular nucleus. No further retrieval attempt was pursued. No further dislocation ofthe loop or clinical event have been reported during the 16-year follow up.DISCUSSION: This case reported a favorable outcome of conservative management for entrapped materialfrom a CPD after iatrogenic damage from failed retrieval. No similar reports are available in the litera-ture, and conservative management is generally not a recommended approach because of the potentialcomplications. However, rescue retrieval attempts are as well a potential source of serious events, andno clear guidelines exist on the management of mechanical complications from CPD.CONCLUSION: Entrapment of CPD components constitutes an adverse event with no unique solution forrisk-free management. The potential risks associated with the use of protection devices are still to befully explored, and improving the standard of care and patient safety needs to be a top priority.