Abstract
Carotid artery stenting (CAS) is an established alternative to endarterectomy, but stent fracture is an under-recognized complication with potential clinical consequences. We report a case of carotid stent fracture in a 69-year-old male with prior neck radiation, presenting with severe in-stent restenosis 10 months post-stenting. To place this case in context, a systematic review of PubMed, Embase, and Scopus (through June 2025) was conducted in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Ten retrospective studies (2365 patients) were included. Stent fracture was identified in 172 patients, with a pooled prevalence of 7.3%. Type I and II fractures were most common, while Type V was rare. Reported risk factors included prior neck irradiation, vessel tortuosity, long stent length, and closed-cell stent design. Fluoroscopy was the most reliable detection method. Restenosis rates varied widely (0%-36%), most patients remained asymptomatic and were managed conservatively. In conclusion, Carotid stent fracture occurs in approximately 7% of cases and is often clinically silent, though it may predispose to restenosis. Surveillance and management should be individualized, with intervention reserved for symptomatic patients or progressive disease.
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