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A Case of Symptomatic Subacute In-stent Thrombosis after Carotid Angioplasty and Stenting for Severe Carotid Stenosis Kota KURISU 1 , Hiroshi MANABE 1 , Tatsuo IHARA 2 1Department of Neurosurgery, National Hakodate Hospital 2Department of Neurology, National Hakodate Hospital Keyword: carotid artery stenosis , carotid artery angioplasty and stenting , subacute in-stent thrombosis , complication , antiplatelet therapy pp.1001-1005
Published Date 2007/10/10
DOI https://doi.org/10.11477/mf.1436100629
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 We report a case of symptomatic subacute in-stent thrombosis after carotid artery angioplasty and stenting (CAS). The patient was a 72-year-old man who had severe asymptomatic right carotid artery stenosis. He received CAS with distal protection, and gained 100% opening of the right carotid artery. The administration of dual antiplatelet therapy (Aspirin100mg/day+Cilostazol100mg/day), which had been given since two weeks before the procedure, was continued afterwords. On the seventh day after the stent placement, the patient showed sudden onset of left hemiparesis and conjugated deviation of both eyes to the right side and followed by falling into a comatose state. Emergency angiography showed near occlusion of the right carotid artery, suggesting subacute in-stent thrombosis. In conjunction with the intravenous administration of tissue plasminogen activator (1300,000IU), we performed additional stent placement on the stented portion of the ICA and gained full recanalization of the ICA about three hours after the onset of the symptoms. The patient showed rapid recovery and returned home with slight clumsiness of his right hand.

 Symptomatic subacute in-stent thrombosis after CAS is a rather rare complication. We discuss on the possible cause of this and stress the necessity of an additional emergency stenting to gain rapid recanalization.


Copyright © 2007, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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