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Fig. 1. Carotid arteriogram in the AP projection demonstrating diffuse symmetrical narrowing in the stent suggestive of intimal hyperplasia. No acute clot is seen.		Fig. 2. Carotid arteriogram in the LAT projection showing similar findings and a jet hitting the anterior wall of the upper stent.
Case Reference No. CC-0498-03 Follow-up case for: Case 0398_07 -- Internal carotid artery pseudoaneurysm following endarterectomy: treatment with covered stent placement A 10-mm x 50-mm Wallgraft (PETcovered) was deployed into the ICA to exclude an iatrogenic pseudoaneurysm. The baseline Doppler ultrasound done one day following the procedure showed normal wave form inside the stent and a velocity in the mid-stent of 65 cm/sec. A routine ultrasound followup was scheduled 3 months later. The patient has done well for three months with no neurological deficits. The 3-month followup Doppler ultrasound was described as technically difficult and the color was not well seen inside the stent. The velocity measured inside the stent was 55 cm/sec. Based on this information, the patient was scheduled for a carotid arteriogram. Figures 1 and 2 demonstrate development of a diffuse intimal hyperplasia creating narrowing in the stent with a jet phenomenon at the end of the stent. Intraarterial pressure measurements were 123/105 mm Hg above the stent and 129/110 mm Hg below the stent representing a small gradient of 6 mm Hg systolic pressure. Questions: 1. Should this lesion be treated and how? 2. If you elect not to treat when would you follow the patient and how? 3. What is the likelihood of stroke in this patient? 4. In retrospect, was it a mistake to put in this covered stent? 5. Can we expect less intimal hyperplasia in covered stents compared to bare stents?