In-stent thrombosis after carotid artery stenting in a patient with protein C deficiency

Iwamoto, Yuichirou; Kitano, Takaya; Matsubara, Shunji; Uno, Masaaki; Yagita, Yoshiki

doi:10.1007/s10072-018-3544-6

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…(6) As in our case, recurrence of stroke has not been observed for 2 years after CAS under anticoagulant therapy with warfarin, and carotid stenting and anticoagulant therapy may be an effective treatment option to prevent ischemic stroke in patients with both carotid web and protein C deficiency. However, careful follow-up is needed because protein C deficiency can cause in-stent thrombus formation after carotid stenting (15). To our knowledge, this is the first report in which thrombus formation on the carotid web following cessation of anticoagulant therapy was confirmed by carotid ultrasonography in a patient with protein C deficiency.…”

Section: Discussionmentioning

confidence: 76%

A Case of Ischemic Stroke With Congenital Protein C Deficiency and Carotid Web Successfully Treated by Anticoagulant and Carotid Stenting

et al. 2020

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Objective: A rare case of thromboembolic cerebral infarction due to carotid web in a patient with congenital protein C deficiency is reported.Case Presentation: A patient in her 40's with left-side hemiparesis was transferred to our hospital under continuous intravenous injection of heparin. Magnetic resonance angiography demonstrated occlusion of the right middle cerebral artery (MCA). Conventional angiography revealed recanalization of the right MCA and a carotid web at the origin of the right internal carotid artery. Ultrasound scan of the carotid artery on the 19th day revealed thrombus formation on the distal portion of the carotid web. We performed carotid artery stenting to prevent thrombus formation by suppressing the carotid web to the vessel wall and by regulating the turbulent flow. The patient had no recurrence of stroke under-anticoagulation with warfarin during the 2-year follow-up period.Conclusion: To our knowledge, this is the first report in which an immediate thrombus formation on the carotid web was observed in a patient with congenital protein C deficiency. In a case of acute ischemic stroke with carotid web, especially when congenital coagulopathy such as protein C deficiency is suspected, careful follow-up with ultrasound imaging should be performed.

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Section: Discussionmentioning

confidence: 76%

A Case of Ischemic Stroke With Congenital Protein C Deficiency and Carotid Web Successfully Treated by Anticoagulant and Carotid Stenting

et al. 2020

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“…Other endovascular management strategies include catheter thrombo-aspiration, balloon angioplasty, and subsequent stent implantation[ 5 , 10 , 13 , 16 ]. These methods are helpful for carotid revascularization, but balloon angioplasty and subsequent stent implantation may cause extra intima injury or damage stent structure.…”

Section: Discussionmentioning

confidence: 99%

Acute carotid stent thrombosis: A case report and literature review

Fan¹,

Chen²,

Liu³

et al. 2022

WJCC

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BACKGROUND Acute carotid stent thrombosis (ACST) is a rare but devastating complication in the carotid artery stenting (CAS) procedure. The aim of this article is to report a case and review cases of ACST reported in the literature, and investigate risk factors and management strategies for ACST. CASE SUMMARY We reviewed the treatment process of a patient with ACST after CAS. Then multiple databases were systematically searched to identify studies reporting ACST from 2005 to 2020. The demographic data, risk factors, treatment strategies, and prognosis were extracted and analyzed. CONCLUSION The reason for ACST is multifactorial. Proper patient selection, normative anti-platelet treatment, and perfect technical detail may decrease the incidence of ACST. Several treatment strategies such as thrombolysis, mechanical thrombectomy, and open surgery may be options for the treatment of ACST. Limited data have shown that carotid endarterectomy is effective with favorable results.

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“…By clinical reasoning, inadequate antiplatelet therapy, thrombotic diathesis, or clopidogrel therapy hyporesponse are presumed as a likely culprit when the CAS procedure itself was successfully completed. 1,2,4,6 Regarding DAPT, it has been shown that “resistance” rates to aspirin or clopidogrel range from 5% to 44%, respectively. 9,10 Therefore, when available, reasonable diagnostics in case of stent thrombosis include a wider set of coagulation tests with additional studies such as platelet aggregometry or pharmacogenetics, primarily for CYP2C19 gene due to its salience for clopidogrel metabolism.…”

Section: Literature Review and Conclusionmentioning

confidence: 99%

“…2,5 According to the available literature, this is the 34th described case of carotid stent thrombosis in early period (<30 days), including all respective reports of such events as an intraprocedural complication. [1][2][3][5][6][7][8] In the most comprehensive review up to date in which 26 cases of early carotid stent thrombosis are presented, an algorithm for the management of acute carotid stent thrombosis has been proposed. 2 This algorithmic approach distinguishes whether the complication occurred intra-or postprocedurally.…”

Section: Literature Review and Conclusionmentioning

confidence: 99%

Acute Carotid Stent Thrombosis in an Ultrarapid Clopidogrel Metabolizer: Case Report and Literature Review

Toljan

Jovanović

Starčević

et al. 2019

Vasc Endovascular Surg

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Introduction: Carotid angioplasty and stenting (CAS) represents an effective procedure for treating carotid artery disease. The acute in-stent thrombosis is an extremely rare complication of CAS especially when it occurs postprocedurally during the first 24 hours. Improper antiplatelet therapy or poor response to antiplatelet medications is known to be associated with a higher risk of in-stent thrombosis during early postprocedural period following a successful intervention. Material and Methods: A patient who experienced acute carotid in-stent thrombosis in early postprocedural period is described. He had been taking dual antiplatelet therapy for 2 weeks before undergoing a successful CAS. Moreover, pharmacogenetics studies showed the patient to be a clopidogrel ultrarapid metabolizer, which theoretically confers hyperresponsivity to medication. Alongside the report itself, a brief literature review of relevant sources pertinent to the case has been conducted. Results: According to the available literature, this is the first case report describing an ultrarapid clopidogrel metabolizer who underwent an uneventful CAS but experienced acute carotid in-stent thrombosis in early postprocedural period. A rescue procedure included an endovascular intervention consisting of thrombectomy and local alteplase application, followed by postprocedural administration of intravenous eptifibatide. At discharge, patient’s dual antiplatelet therapy included ticagrelor instead of clopidogrel. Conclusion: Acute carotid in-stent thrombosis is a highly unexpected complication of CAS and can occur despite ultrarapid clopidogrel metabolism trait.

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In-stent thrombosis after carotid artery stenting in a patient with protein C deficiency

Cited by 4 publications

References 6 publications

A Case of Ischemic Stroke With Congenital Protein C Deficiency and Carotid Web Successfully Treated by Anticoagulant and Carotid Stenting

A Case of Ischemic Stroke With Congenital Protein C Deficiency and Carotid Web Successfully Treated by Anticoagulant and Carotid Stenting

Acute carotid stent thrombosis: A case report and literature review

Acute Carotid Stent Thrombosis in an Ultrarapid Clopidogrel Metabolizer: Case Report and Literature Review

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