In Reply to: Case 0498_03 --Rapid intimal hyperplasia in a covered carotid stent posted by Editor on March 31, 1998 at 14:53:16:
I don't think this is intimal hyperplasia. I believe it is rather laminated clot inside the stent similar to what one sees inside the aortic aneurysms. Why it happened? May be the 10 mm diameter of Wallgraft was too wide for this vessel. It is true that we place 10 mm bare stent in carotids but we dilate only to 6mm which gives us excellent visual result. Here due to previous endarterectomy the recepient lumen could have been bigger resulting in 10 mm disention of the Wallgraft which is an oversize. Anyway, perhaps MRI can differentiate clot from intimal hyperplasia.
Was it a mistake to place a covered stent here. I think the choice of the length 20 vs 50 mm (for which you may have had no control depending on availability) was perhaps more mistake than the concept of placing a covered stent. I also think clot retraction may explain the observation of improvement over time better than spontaneous regression of intimal hyperplasia as suggested by ST.