FIG 1. A case of long-term stent patency in patient 4, a 68-year-old woman with thyroidectomy for carcinoma followed by postoperative radiation, bilateral radical neck dissection, and permanent tracheostomy, who experienced transient ischemic changes in the left cerebral hemisphere 21 years after radiation therapy. The patient had a history of graft placement between her left CCA and left subclavian arteries (5 years before admission) as well as a right CCA vein graft bypass (10 years before admission).

A, Digital subtraction angiography (DSA) reveals a 70% stenosis (arrow) of the distal left CCA. Note the bypass graft (arrowhead) between the left CCA and left subclavian arteries.

B, Successful stent placement with little residual stenosis. The proximal end of the 8 x 40 mm Wallstent (Boston Scientific, Natick, MA) extends across the origin of the left subclavian graft (arrow). Poststent angioplasty with an 8 x 40 mm Olbert balloon (Boston Scientific) resulted in rupture of the balloon.

C, Repeat DSA 4.5 years after stent placement shows a patent carotid artery with interval auto expansion of the stent.