Acute Carotid Artery Stent Thrombosis

Cvjetko, Ivan; Bacalja, Inga Đaković; Cvjetko, Tereza

doi:10.1007/s00270-017-1808-9

Cited by 4 publications

(2 citation statements)

References 2 publications

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“…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 is an extremely rare event, with 5 case reports describing its occurrence in the first 24 hours postprocedurally. [1][2][3] Direct procedural causes of stent thrombosis include vessel injury, atheroma prolapse, and kinking or coiling of internal carotid artery (ICA), whereas improper antithrombotic regimen and a tendency to hypercoagulability appear as notable risk factors when considering early postprocedural complications. 1,2,4 By authors' knowledge and available literature (per PubMed and Google Scholar database searches; current as of March 2019), this is the first case of a patient with ultrarapid clopidogrel metabolism trait exhibiting acute carotid stent thrombosis.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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