We present three male patients with procedural complications of acute stent thrombosis, hyperperfusion syndrome, and minor transient ischemic attack because of stent fracture. All complications had occurred despite the fact of rigorous prior- and postprocedural use of dual antiplatelet therapy, post stent-implantation angioplasty and meticulous use of carotid filters.

Acute stent thrombosis that we present happened to 69-year-old-male patient with appropriate preprocedural dual antiplatelet therapy most possibly due to plaque prolapse (Figures 1-3), and acute in-stent thrombosis happened at the end of the procedure which has been resolved by direct aspiration with large bore aspiration catheter and administration of tirofiban (Figure 4). Multiple plaque fragments were documented within the net of carotid filter. (Figure 5).  

Hyperperfusion syndrome was verified in 78-year-old male patient treated for severe right ICA stenosis (Figures 6-8). Few hours after otherwise uneventful procedure of carotid artery stenting it was reported that the patient had suffered from epileptic seizure with altered mental status that has lasted for 1 week. Postprocedural Brain CT did not reveal signs of acute ischemic stroke. 

Stent fracture was subsequently detected with CTA in 64-year-old patient after he reported multiple minor neurological deficits (TIAs) to attending neurologist (Figures 10-14). The patient was not referred for Brain CT/MRI examination since there was no clinical evidence that the patient had suffered ischemic stroke. Within one-month successful angioplasty of the stent was performed.