Abstract

Embolic protection device (EPD) is a well-described adjunct in carotid artery stenting for its benefit of reducing perioperative stroke, but EPD retrieval is sometimes challenging, especially in elderly patients. We described a 73-year-old patient of EPD retrieval difficulty with falling of the guide catheter into hostile aortic arch during the right carotid open-cell stent placement under filter device. In this case, type III arch, tortuosity distal to stenosis and calcified plaque resulted in angulated path, made filter wire entrapped in stent struts, and pulled back guide catheter into aortic arch. A 6-French Sofia intermediate catheter was performed to bail the operator out and retrieve the EPD which was unsuccessfully resolved by all the other methods. The Sofia intermediate catheter is a valuable and final tool to resolve an EPD retrieval difficulty, especially when the filter wire is trapped in the stent and the guide catheter loses an access to carotid artery in elderly patients.