Delayed plaque protrusion after carotid artery stenting for the patient with symptomatic bi-lateral carotid artery stenosis.

Carotid artery stenting (CAS) has been developed as an alternative therapeutic strategy for carotid endarterectomy (CEA) for the past several decades. One of the remaining issues of CAS is the relatively higher incidence of ipsi-lateral stroke after the procedure compared with CEA. Ischemic stroke after CAS sometimes occurred after catheterization, and a major cause of delayed stroke has been hypothesized to be stent-thrombosis. In this report, we present a case of a delayed plaque protrusion observed by contrast enhanced computed tomography and intravascular ultrasound, which could be the cause of the delayed recurrence of ischemic symptom. The lesion required an additional endovascular treatment to relieve the patient of the recurrence. This phenomenon might be a possible reason for the delayed ischemic stroke after CAS.