Carotid Stent: Device-Specific Complications With the Wallstent

Abstract The carotid Wallstent is one of the most used stents in the endovascular treatment of carotid stenosis, because its closed cell design means that it is adequate for both stable uncomplicated plaques and dishomogenous stenosis. The drawback of its versatility is reduced conformability caused by the rigidity of the device, which also leads to difficult positioning in tortuous vessels. In cases of very tight stenosis or excessive tortuosity of the vessel, the radial forces of the stent struts may determine slipping of the stent either proximally or distally to the target zone, even at late follow-up. Complications from the carotid Wallstent (Boston Scientific, Marlborough, MA) are rare, with few cases of asymptomatic occlusion or significant restenosis reported in the literature. Kinking of the distal internal carotid artery is also possible because of the rigidity of the device. Carotid Wallstents behave therefore suboptimally in very tortuous vessels. The length of the stent should be limited to a minimum in tortuous or angulated vessels, but should be calculated considering the shortening of the stent in its wider proximal end. If the shortening is greater than expected, an adjunctive proximal stent may be added because proximal plaque coverage is essential for satisfactory long-term results. Distal significant late restenosis may be successfully treated with distal stent extension, paying attention not to cause further distal kinking. Surgical stent removal and complete carotid endarterectomy may be necessary only exceptionally.