Inadvertent carotid artery occlusion due to a stent-related accordion effect: Clinical experience with a retrievable stent to unfold the vascular wall and restore flow

Inadvertent occlusion of an internal carotid artery (ICA) during stenting may be a catastrophic situation requiring a bailout operation to prevent permanent neurologic sequelae. The underlying mechanisms of ICA occlusion may include filterrelated flow arrest, arterial dissection, vasospasm, and the accordion effect, and timely differential diagnosis is crucial for appropriate management. We present herein a case of stenting-related accordion effect that led to complete ICA occlusion, wherein temporary placement of a retrievable intracranial stent for rescue was successful in achieving flow restoration, but further complicated by engagement with the filter. The differential diagnosis, preventive measures, and management of the accordion effect are discussed.