scholarly journals Acute In-Stent Thrombosis after Carotid Angioplasty and Stenting: A Case Report and Literature Review

2018 ◽  
Vol 7 (5) ◽  
pp. 265-270 ◽  
Author(s):  
Wei Hu ◽  
Li Wang ◽  
GuoPing Wang
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Stent Thrombosis ◽  
Controlled Trial ◽  
Recombinant Tissue Plasminogen Activator ◽  
Internal Carotid Artery Stenosis ◽  
Invasive Treatment ◽  
Carotid Revascularization ◽  
Acute Stent Thrombosis ◽  
Protection Filter

Background: Based on the results of a recent randomized controlled trial, carotid artery stenting (CAS) was regarded as a relatively safe, less invasive treatment of internal carotid artery stenosis. However, cerebral thromboembolic events are the most common complications of CAS. Especially acute stent thrombosis following CAS will be fatal without prompt diagnosis and revascularization. Case Report: We report a case of acute stent thrombosis in whom carotid revascularization was performed successfully via arterial thrombolysis and balloon postdilation. A 79-year-old man with hypertension was hospitalized for an episode of transient ischemic attack. Computed tomography angiography revealed subtotal occlusion in the left carotid artery. Aspirin (100 mg) and clopidogrel (75 mg) were administered daily for 5 days before the procedure. CAS was performed under local anesthesia. The first postprocedural angiogram showed the stent looked good. However, a repeat angiogram showed in-stent thrombosis 2 min after withdrawal of the cerebral protection filter. Interestingly, the patient presented no neurologic deficit. After an additional 2,000 U of heparin had been administered intravenously, a microcatheter (SL-14; Boston Scientific, USA) was positioned to the in-stent thrombosis. Next, a total dose of 10 mg of recombinant tissue plasminogen activator was injected into the thrombus via the microcatheter within 10 min, which led to partial recanalization with antegrade flow. However, complete occlusion of the lesion occurred 5 min later. Under the guidance of angiography roadmap, a protection filter (Emboshield NAV6; Abbott Vascular, USA) was deployed at the distal part of the stent and redilation of the stent was performed with a 5 × 30 mm balloon (Viatrac 14 Plus; Abbott Vascular) at 14 atm. Finally, carotid revascularization was performed successfully, proven by postprocedural angiogram. Conclusion: Acute carotid stent thrombosis (ACST) can have devastating effects on the survival of the patient. For ACST when the stent does not fully adhere to the blood vessel, a mechanical approach should be a feasible solution to the problem.

Sandwich Stenting Technique Successfully Performed for Acute Carotid Artery Stent Thrombosis: A Case Report

2018 ◽  
Vol 21 (1) ◽  
pp. 79-81
Author(s):  
Abdullah İçli ◽  
Ahmet Lütfü Sertdemir ◽  
Kurtuluş Özdemir
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Stent Thrombosis ◽  
Carotid Artery Stent

Coronary muscular bridge mimicking acute stent thrombosis : case report

2012 ◽  
Vol 23 (1) ◽  
pp. e16-e17
Author(s):  
C.Y. Karabay ◽  
A.C. Aykan ◽  
A. Guler ◽  
E. Alizade ◽  
A. Kalayci ◽  
...  
Keyword(s):  
Case Report ◽  
Stent Thrombosis ◽  
Acute Stent Thrombosis

Emergent Carotid Thromboendarterectomy for Acute Symptomatic Occlusion of the Extracranial Internal Carotid Artery

2017 ◽  
Vol 51 (4) ◽  
pp. 176-182 ◽  
Author(s):  
Igor Gunka ◽  
Dagmar Krajickova ◽  
Michal Lesko ◽  
Stanislav Jiska ◽  
Jan Raupach ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Time Interval ◽  
Nihss Score ◽  
Carotid Revascularization ◽  
Extracranial Ica

Background: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. Methods: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015. Primary outcomes were disability at 90 days assessed by the modified Rankin Scale (mRS) and neurological deficit at discharge assessed using the National Institute of Health Stroke Scale (NIHSS). Secondary outcomes were the recanalization rate, 30-day overall mortality, and any intracerebral bleeding. Results: During the study period, a total of 6 patients (5 men and 1 woman) with a median age of 64 years (range: 58-84 years) underwent emergent reconstruction for acute symptomatic ICA occlusion within a median of 5.4 hours (range: 2.9-12.0 hours) after symptoms onset. The median presenting NIHSS score was 10.5 points (range: 4-21). Before surgery, 4 patients (66.7%) had been treated by systemic recombinant tissue plasminogen activator lysis. The median time interval between initiation of intravenous thrombolysis and carotid thromboendarterectomy was 117.5 minutes (range: 65-140 minutes). Patency of the ICA was achieved in all patients. On discharge, the median NIHSS score was 2 points (range: 0-11 points). There was no postoperative intracerebral hemorrhage and zero 30-day mortality rate. At 3 months, 5 patients (83.3%) had a good clinical outcome (mRS ≤ 2). Conclusion: Patients presenting with minor to severe ischemic stroke syndromes due to isolated extracranial ICA occlusion may benefit from emergent carotid revascularization. Thorough preoperative neuroimaging is essential to aid in selecting eligible candidates for acute surgical intervention.

scholarly journals A New Concept for Carotid Artery Stenting: Coating the Atherosclerotic Plaque by Covered Stent before Bare Stent Implantation

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Erol Akgul
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Stent Thrombosis ◽  
Atherosclerotic Plaque ◽  
Stent Implantation ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Balloon Dilation ◽  
Covered Stent ◽  
Extracranial Carotid Artery

In carotid artery stenting (CAS) procedures, distal embolism, periprocedural stent thrombosis, and 30-day stroke due to the plaque fragmentation and protrusion caused by stent implantation and balloon dilation are frequent complications. In this technical case report, a case is presented of extracranial carotid artery stenosis treated with a covered stent and subsequent implantation of a bare stent. In addition, the possibility is discussed that this new technique prevents the distal microembolic complications, periprocedural stent thrombosis, and 30-day stroke of extracranial CAS.

scholarly journals Stent-in-stent treatment for acute in-stent thrombosis after carotid artery stenting: a case report

2012 ◽  
Vol 6 (3) ◽  
pp. 181-188 ◽  
Author(s):  
Yuji TAKASUGI ◽  
Kenji SUGIU ◽  
Masafumi HIRAMATSU ◽  
Yu OHKUMA ◽  
Hisakazu ITAMI ◽  
...  
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Stent Thrombosis ◽  
Carotid Artery Stenting ◽  
Stent Treatment

scholarly journals Revascularization of Acute Stent Thrombosis after  Carotid Artery Stenting in a Clopidogrel Resistance Patient

2019 ◽  
Author(s):  
Wei Wei ◽  
Yan Wang ◽  
Pian Wang ◽  
Qingbin Zhang ◽  
Qian Yu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Carotid Artery Stenting ◽  
Rare Event ◽  
Treatment Strategies ◽  
Platelet Glycoprotein ◽  
Clopidogrel Resistance ◽  
Vessel Dissection ◽  
Acute Stent Thrombosis

Abstract Carotid artery stenting (CAS) is an alternative strategy to prevent ischemic stroke in patients who are at high risk of surgery compared with carotid endarterectomy (CEA). Acute carotid stent thrombosis (ACST) is an extremely rare but devastating complication after CAS. Theoretically , it occurs within 30 days after CAS . There are several reasons causing ACST, such as inadequate antiplatelet therapy, early discontinuation of antiplatelet therapy, clopidogrel resistance, hypercoagulable state, local vessel dissection, vasospasm, and intimal injury. Although successful recanalization cases have been reported, there is still a lack of experience in the choice of treatment methods and the timing of ACST treatment, especially when the patient has clopidogrel resistance. Here, we report a case with successful revascularization after ACST in a patient with evidenced clopidogrel resistance, which was further confirmed by genetic testing.In this case, both thrombus aspiration and platelet glycoprotein IIb/IIIa antagonist (GPIs) were used for recanalization. In addition, we review the literature and discuss appropriate treatment strategies for this devastating and rare event.

scholarly journals Acute stent thrombosis in a sirolimus eluting stent after wasp sting causing acute myocardial infarction: a case report

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
pp. 7800 ◽  
Author(s):  
Martin Greif ◽  
Tilmann Pohl ◽  
Nico Oversohl ◽  
Christopher Reithmann ◽  
Gerhard Steinbeck ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Case Report ◽  
Stent Thrombosis ◽  
Wasp Sting ◽  
Sirolimus Eluting Stent ◽  
Acute Stent Thrombosis
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