case_images: PMC10507256_01
case_images: (A,B) Right internal carotid artery origin was 82% stenosed (North American Symptomatic Carotid Endarterectomy Trial method) according to the results of right common carotid artery angiography (ICA). (C,D) CASPER Rx was placed at the right ICA; the blood flow improved. [(A,C), anteroposterior view; (B,D), lateral view].
case_images: fneur-14-1152173-g001.jpg
case_images: PMC10507256_01_fneur-14-1152173-g001.jpg
case_images: fig1
case_images: Right common carotid artery angiography revealed 82% stenosis (North American Symptomatic Carotid Endarterectomy Trial method), even though it was asymptomatic (Figures 1A,B); therefore, after beginning DAPT (aspirin and clopidogrel), CAS utilizing CASPER Rx (Terumo, Tokyo, Japan) was conducted (Figures 1C,D).
case_images: (A) Using ultrasonography, neointimal formation in CASPER Rx could not be detected (white arrowheads: CASPER Rx). (B) A radiolucent gap between the stent and artery lumen was discovered during right common carotid angiography. (C) Using angioscopy, thin neointimal development was seen throughout, except for the external carotid artery orifice (black arrowheads: the orifice of the external carotid artery).
case_images: fneur-14-1152173-g002.jpg
case_images: PMC10507256_01_fneur-14-1152173-g002.jpg
case_images: fig2
case_images: Two months after CAS, another workup with angiography and angioscopy was conducted because it was challenging to detect the neointima within the stent using CUS (Figure 2A). After systemic heparinization, right common carotid angiography showed a radiolucent gap between the stent and lumen of the artery, suggesting neointimal formation (Figure 2B). After that, thin neointimal development was observed throughout the stent, except for the external carotid artery orifice, where the lumen was visually inspected with an angioscope VISIBLE (Intertec Medicals, Osaka, Japan) under proximal blood flow obstruction with a balloon catheter (Figure 2C).