{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T20:58:00Z","timestamp":1760043480142,"version":"3.40.4"},"reference-count":14,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Carotid artery stenting (CAS) has become a widely used treatment for carotid artery stenosis, especially in high-risk patients. Acute in-stent and distal protection device occlusion are potentially catastrophic complications of this procedure. Previously described rescue strategies have included administration of antiplatelet agents (eg, abciximab) with\/without thrombolytics and removal of the filter. Here we describe the successful resolution of in-stent occlusion by mechanical thrombolysis using the Penumbra 4Max aspiration catheter. Distal flow was subsequently restored with minimal residual stenosis. The patient did not suffer any consequent neurological deficits. The different strategies that could be used in this critical situation are reviewed.<\/jats:p>","DOI":"10.1136\/bcr-2013-010706","type":"journal-article","created":{"date-parts":[[2013,10,14]],"date-time":"2013-10-14T10:13:28Z","timestamp":1381745608000},"page":"bcr2013010706","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Recanalization of acute carotid stent occlusion using Penumbra 4Max aspiration catheter: technical report and review of rescue strategies for acute carotid stent occlusion"],"prefix":"10.1136","volume":"2013","author":[{"given":"Stephan","family":"Munich","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roham","family":"Moftakhar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demetrius","family":"Lopes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,10,14]]},"reference":[{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.1","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1056\/NEJMoa040127","article-title":"Protected carotid artery stenting versus endarterectomy in high-risk patients","volume":"2013","author":"Yadav","year":"2004","journal-title":"N Engl J Med"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.2","first-page":"1750","article-title":"Abciximab rescue in acute carotid stent thrombosis","volume":"2013","author":"Tong","year":"2000","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.3","first-page":"331","article-title":"Current status in cervical carotid artery stent placement","volume":"2013","author":"Wholey","year":"2003","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.4","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1161\/hs0202.102337","article-title":"Cerebral protection during carotid artery stenting: collection and histopathologic analysis of embolized debris","volume":"2013","author":"Angelini","year":"2002","journal-title":"Stroke"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.5","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0150-9861(05)83125-6","article-title":"Angioplasty and stenting of the cervical carotid bifurcation under filter protection: a prospective study in a series of 53 patients","volume":"2013","author":"Bonaldi","year":"2005","journal-title":"J Neuroradiol"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.6","doi-asserted-by":"crossref","first-page":"494","DOI":"10.3174\/ajnr.A2818","article-title":"Clinical implications of internal carotid artery flow impairment caused by filter occlusion during carotid artery stenting","volume":"2013","author":"Kwon","year":"2012","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.7","first-page":"1411","article-title":"Successful revascularization of acute carotid stent thrombosis by facilitated thrombolysis","volume":"2013","author":"Steiner-Boker","year":"2004","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1258\/vasc.2011.cr0303","article-title":"Acute carotid stent thrombosis: a case of surgical revascularization and review of treatment options","volume":"2013","author":"Markatis","year":"2012","journal-title":"Vascular"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.9","first-page":"103","article-title":"Carotid stenting with filter protection. Correlation of ACT values with angiographic and histopathologic findings","volume":"2013","author":"Castellan","year":"2003","journal-title":"J Neuroradiol"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.10","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.carrev.2009.02.008","article-title":"Acute carotid stent thrombosis: review of the literature and long-term follow-up","volume":"2013","author":"Iancu","year":"2010","journal-title":"Cardiovasc Revasc Med"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.11","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1002\/(SICI)1097-0304(199605)38:1<38::AID-CCD9>3.0.CO;2-4","article-title":"Porcine model of stent thrombosis: platelets are the primary component of acute stent closure","volume":"2013","author":"Jeong","year":"1996","journal-title":"Cathet Cardiovasc Diagn"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.12","first-page":"87","article-title":"Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb\/IIIa blockade","volume":"2013","year":"1998","journal-title":"Lancet"},{"key":"2025042709284560000_2013.oct14_1.bcr2013010706.13","doi-asserted-by":"crossref","first-page":"267","DOI":"10.3949\/ccjm.65.5.267","article-title":"The EPILOG trial. Abciximab prevents ischemic complications during angioplasty. 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