Τίτλος:
Acute Early Carotid Stent Thrombosis: A Case Series
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background Acute early carotid stent thrombosis (AcuteCST) is a rare complication after carotid artery stenting (CAS). The purpose of this retrospective study was to investigate the incidence, causes, and optimal management of AcuteCST. Methods Medical records of all patients undergoing CAS between 2008 and 2016 were retrospectively reviewed. The time of thrombosis, grade of stenosis, lesion side, preprocedural and postprocedural anticoagulants, causes, symptoms, treatment, recanalization, and outcome were reviewed. Results Overall, 674 patients were treated with CAS. Four cases of AcuteCST were identified (0.59%). In the first patient, the stent thrombosis was attributed to dissection caused by filter deployment within a distal internal carotid artery with 360° coiling. Notably, in 3 of the 4 cases of thrombosis a second overlapping stent had been deployed. In total, 41 patients of the cohort under investigation underwent overlapping stent deployment. The use of a second overlapping stent as a bail-out procedure due to dissection or malposition or due to long lesions was correlated with increased rate of thrombosis (3/41 [7.3%] vs. 1/633 [0.002%]). In 2 patients, carotid stents were thrombosed within 2 hr of the procedure. Endovascular thrombus aspiration and subsequent eversion carotid endarterectomy with stent explantation in the first patient and intrathrombus urokinase administration with thromboaspiration and additional stent placement in the second patient were followed. In the other 2 patients having their carotid stents thrombosed 3 and 4 days after the procedure, treatment with low weight molecular heparin and antiplatelet regimens was followed. Conclusions The use of overlapping stents in the carotid artery is a predisposing factor for AcuteCST. Prognostic factors of this potentially devastating complication are the initial clinical presentation expressing the grade of ischemic brain damage, the accurate and timely recognition of the thrombosis, and the prompt restoration of oxygenated blood flow into the viable tissue at risk of infarction. © 2017 Elsevier Inc.
Συγγραφείς:
Moulakakis, K.G.
Kakisis, J.
Tsivgoulis, G.
Zymvragoudakis, V.
Spiliopoulos, S.
Lazaris, A.
Sfyroeras, G.S.
Mylonas, S.N.
Vasdekis, S.N.
Geroulakos, G.
Brountzos, E.N.
Περιοδικό:
Annals of Vascular Surgery
Εκδότης:
HANLEY & BELFUS-ELSEVIER INC
Λέξεις-κλειδιά:
acetylsalicylic acid; antithrombocytic agent; clopidogrel; nadroparin; tinzaparin; urokinase; anticoagulant agent, acute early carotid stent thrombosis; aged; aphasia; Article; ataxic aphasia; carotid angioplasty; carotid artery bifurcation; carotid artery obstruction; carotid artery stenting; carotid endarterectomy; cerebrovascular accident; computed tomographic angiography; computer assisted tomography; conservative treatment; digital subtraction angiography; dizziness; drug withdrawal; dual antiplatelet therapy; dysarthria; explant; female; heart infarction; hemiparesis; human; hypertensive crisis; in-stent restenosis; incidence; internal carotid artery; lung edema; major clinical study; male; mechanical thrombectomy; middle cerebral artery; percutaneous thrombectomy; priority journal; recanalization; retrospective study; stent thrombosis; thrombus aspiration; transient ischemic attack; carotid artery disease; carotid artery thrombosis; case report; device removal; devices; diagnostic imaging; early diagnosis; embolic protection device; endovascular surgery; fibrinolytic therapy; predictive value; risk factor; stent; thrombectomy; time factor; treatment outcome, Aged; Angiography, Digital Subtraction; Anticoagulants; Carotid Artery Diseases; Carotid Artery Thrombosis; Computed Tomography Angiography; Device Removal; Early Diagnosis; Embolic Protection Devices; Endarterectomy, Carotid; Endovascular Procedures; Female; Humans; Male; Platelet Aggregation Inhibitors; Predictive Value of Tests; Retrospective Studies; Risk Factors; Stents; Thrombectomy; Thrombolytic Therapy; Time Factors; Treatment Outcome
DOI:
10.1016/j.avsg.2017.04.039
