Document resource
Background Extracranial carotid artery stenting in infants and toddlers is rarely reported and presents unique challenges including vessel growth considerations, stent-artery size mismatch, and long-term restenosis risk. We report technical feasibility and mid-term outcomes of carotid artery stenting in a 22-month-old child with medically refractory high-grade stenosis and recurrent hemispheric infarctions.Materials and Methods A 22-month-old female with complex congenital anomalies including cleft palate, hypotonia, metopic craniosynostosis, Moebius syndrome, and chromosomal abnormalities (6p duplication and 10q25-26 deletion) presented with recurrent hemispheric ischemic infarctions despite antithrombotic therapy. Vascular imaging demonstrated near-occlusive left extracranial internal carotid artery (ICA) stenosis measuring 94% by North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. The patient underwent percutaneous transluminal angioplasty (PTA) of the left cervical ICA followed by deployment of overlapping self-expanding stents due to persistent residual stenosis after initial angioplasty and first stent placement. Periprocedural glycoprotein IIb/IIIa inhibition (eptifibatide infusion) was administered with transition to dual antiplatelet therapy (aspirin 40.5 mg and clopidogrel 10 mg daily). Final angiography demonstrated 19% residual stenosis by NASCET criteria.Results The procedure was completed without periprocedural complications. No symptomatic intracranial hemorrhage, or neurological deterioration occurred during the immediate postprocedural period. Over 55 months of surveillance, serial magnetic resonance angiography confirmed durable stent patency without in-stent restenosis or occlusion. No new ipsilateral cerebral infarctions occurred during follow-up. The patient demonstrated stability and improvement in developmental milestones across gross motor, fine motor, and language domains.Conclusions This case demonstrates the technical feasibility and favorable mid-term outcomes of extracranial carotid artery stenting in a highly selected toddler with medically refractory high-grade stenosis and recurrent hemispheric ischemia. Careful patient selection, meticulous procedural technique, tailored antiplatelet management, and rigorous multidisciplinary surveillance may yield durable patency and stroke prevention in this challenging pediatric population. Long-term follow-up is essential to assess vessel growth, stent integrity, and late restenosis in this age group.Disclosures G. Kaur: None. K. Pfeiffer: None. C. Gomez: None. A. Qureshi: None.Abstract E-136 Figure 1