• Susumu Yamaguchi, Junpei Hamabe, Nobutaka Horie, Aya Yamashita, Junji Irie, Yoshihiro Tokuda, Kazuo Mutsukura, Nobuhiro Yagi, and Kazuhiko Suyama.
• Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan. Electronic address: ssmymgc@gmail.com.
• World Neurosurg. 2018 Oct 1; 118: 203-208.

BackgroundMechanical thrombectomy improves functional outcomes in patients with acute ischemic stroke. However, stent retrievers have the risk of vascular damage.Case DescriptionWe present 2 cases of patients with acute internal carotid artery occlusion who experienced removal of the intima by a stent retriever. In both patients, a 6 × 30-mm Solitaire stent was fully deployed from the M2 portion and slowly withdrawn. White membranes were retrieved outside the strut in both patients. Histopathologic examination showed that one membrane consisted of thickened intima and internal elastic lamina and the other consisted of calcified intima and internal elastic lamina. One patient who suffered embolic stroke experienced recurrent infarction within 24 hours after operation, and the damaged vessel was occluded on magnetic resonance angiography 21 days after stroke. In another patient with carotid artery dissection, the damaged vessel showed asymptomatic stenosis on magnetic resonance angiography 90 days after stroke. Arteries with both atherosclerosis and vessel dissection may be vulnerable to high radial expansion force.ConclusionsFull deployment of a relatively large-sized stent into a vulnerable vessel may cause vessel dissection after removal of the intima. Appropriate material selection and treatment strategy while considering stroke etiology and the occlusion site are important to prevent vessel damage.Copyright © 2018 Elsevier Inc. All rights reserved.

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