A case of iliac artery injury treated by covered stent during carotid artery stenting

Here we describe a case of iliac artery injury during carotid artery stenting (CAS) treated by covered stent. A 74-year-old man underwent CAS for asymptomatic right carotid artery stenosis. Under local anesthesia, the right common femoral artery was punctured and an 8 Fr long sheath introducer was placed. However, the sheath kinked because the iliac artery was tortuous. We introduced the stylet to the sheath again and tried to extend the kinking. It failed, and the arterial dissection was identified at the lateral iliac artery. The kink was extended with triple coaxial system, i.e. guidewire, coaxial catheter, and a guiding catheter; CAS was performed with distal filter protection. Before removal of the sheath, the right iliac artery was examined, and extraversation of the contrast medium was observed. The balloon catheter was placed to the lesion and dilated for the hemostasis. However, it failed, and the covered stent was placed subsequently. Although blood tests revealed anemia and CT showed retroperitoneal hematoma after the treatment, further complication did not occur. Treatment with covered stent for the vessel injury was effective.