Transcarotid artery revascularization for in-stent restenosis complicated by flow reversal occlusion

We report a case of symptomatic high grade in-stent restenosis of a prior placed transradial carotid artery stent. We performed a Transcarotid Artery Revascularization (TCAR) to treat this symptomatic restenosis. The TCAR was complicated by occlusion of our flow reversal system by a large atherosclerotic embolus. We performed a distal common carotid cutdown to retrieve the occlusive embolus and restored flow reversal. Completion neck and cerebral angiogram showed no filling defect, and our patient showed no neurologic deficit, and resolution of pre-operative symptoms.