Unusual complication of carotid artery stenting as the result of a proximal emboli protection device (the Mo.Ma): Iatrogenic common carotid artery dissection

The safety and efficacy of carotid artery stenting (CAS) with the use of emboli protection devices (EPDs) have been demonstrated in the treatment of atherosclerotic carotid artery disease (CAD) (1). CAS has even recently become more popular than carotid endarterectomy (CEA) in the treatment of CAD thanks to newly developed techniques, including open or closed cell stents and protection devices, as well as special wires and catheters (1-3). Cerebral EPDs reduce the incidence of peri-procedural embolic events in patients undergoing CAS (4). Several EPDs have been designed and marketed so far. Distal emboli protection (filter) devices (d-EPD) and proximal emboli protection devices (p-EPD) are the two most frequently used EPDs systems (5). The Mo.Ma device (Medtronic Inc., Santa Rosa, CA, USA), which was approved by the Food and Drug Administration in 2009, is a pEPD commonly used in high-risk patients for the protection from cerebrovascular embolic events (6). Although the Mo.Ma device was substantially successful, it may lead to some complications, including arterial vasospasm and arterial dissection during the inflation of the proximal and distal balloon (6). Here we present a serious common carotid artery dissection as a result of using the Mo.Ma device during CAS.