We present a case of symptomatic
carotid artery thrombosis treated with
catheter intervention under proximal occlusion and flow reversal embolic protection. Although
catheter intervention is contraindicated in
carotid artery thrombosis due to the risk of distal embolization, the introduction of proximal occlusion
embolic protection devices allow interventionalists to use
catheter intervention where it was previously deemed too high a risk. A Gore Flow Reversal device was used in a 57-year-old male with
obesity, uncontrolled type I
diabetes mellitus,
hypertension,
hyperlipidemia, and prior
stroke who had previously undergone left internal carotid artery revascularization with carotid artery
endarterectomy and patch angioplasty. Since balloon disruption and manual aspiration through the balloon sheath of the flow reversal device was unable to remove the
thrombosis, an AngioJet 4 Fr RX
catheter was used to mechanically remove material via mechanical
thrombectomy. As there was still residual
stenosis, a
stent was placed in the area to decrease the remaining blockage. Follow-up carotid artery duplex scanning showed that the procedure eliminated the carotid occlusion. The
embolic protection device and the procedural technical aspects are described herein, as are reports of both clinical and anatomical follow-up. We show that by using a Gore Flow Reversal protection device, we were able to use
catheter therapy to treat a
carotid thrombosis, which was previously contraindicated for this condition.