Document Detail


Acute carotid stent thrombosis: review of the literature and long-term follow-up.
MedLine Citation:
PMID:  20347802     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Carotid artery stenting (CAS) is a reasonable alternative to carotid endarterectomy, especially in patients at high risk for surgery. Carotid stent thrombosis can cause thrombembolic events, but fortunately, it is a very rare complication. We present two cases of carotid stent thrombosis and their long-term follow-up. CASE REPORTS: One patient had severe bilateral carotid stenosis and the other had contralateral carotid occlusion. Both patients were on correct antithrombotic treatment and received balloon expandable stents (bare metal stent and drug-eluting stent). During CAS, large thrombus formed within the stent followed by rapid hemodynamic and neurological alteration. We gave a bolus thrombolytic in the clot, followed by continuous intra-arterial infusion. In one case, we performed additional angioplasty. Repeated angiography showed complete resolution of the thrombus, followed by progressive improvement in the neurological state. At discharge, the patients had no neurological deficits. CT scans revealed no acute ischemic lesions. One patient had in-stent restenosis 3 years later, which was treated with an additional self-expandable stent. The last follow-up was done 4 and 9 years, respectively, from the initial CAS complication. Both patients did not experience any neurological events after the last procedure. CONCLUSIONS: Carotid stent thrombosis is a rare but potentially fatal complication following CAS. Rapid invasive diagnosis and reperfusion should be done to limit cerebral ischemia. The possible causes must be sighted and reperfusion must be started. Despite an initial dramatic course, a rapid reperfusion ensures a complete neurological recovery and a good prognosis in the long term.
Authors:
Adrian Iancu; Csongor Grosz; Alexandra Lazar
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Cardiovascular revascularization medicine : including molecular interventions     Volume:  11     ISSN:  1878-0938     ISO Abbreviation:  Cardiovasc Revasc Med     Publication Date:    2010 Apr-Jun
Date Detail:
Created Date:  2010-03-29     Completed Date:  2010-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101238551     Medline TA:  Cardiovasc Revasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  110-3     Citation Subset:  IM    
Affiliation:
Heart Institute, Cluj Napoca, Romania.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Angioplasty, Balloon / adverse effects*,  instrumentation*
Brain Ischemia / etiology,  therapy
Carotid Stenosis / therapy*
Fibrinolytic Agents / administration & dosage
Humans
Infusions, Intra-Arterial
Male
Recurrence
Stents*
Stroke / etiology,  therapy
Thrombolytic Therapy
Thrombosis / etiology*,  radiography,  therapy,  ultrasonography
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents

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