A case of repeated acute phase in-stent thrombosis following carotid artery stenting: case report

Abstract

Objective: In-stent thrombosis following carotid artery stenting (CAS) is a devastating complication. We report a rare case of repeated in-stent thrombosis with a complicated clinical course.
Case presentation: A 68-year-old male with bilateral internal carotid artery stenosis underwent right CAS without any complications. Repeated postoperative stent occlusions developed due to in-stent thrombosis at postoperative day 5, 10, 14 respectively after left CAS, which was performed 2 months after the right CAS. The thrombosis occurred repeatedly despite endovascular treatments including clot disruption / aspiration / intraarterial urokinase infusion / angioplasty / stenting and maximized pharmacotherapy including dual antiplatelet therapy and anticoagulation using heparin / warfarin. The patient eventually developed an intracerebral hemorrhage at day 17.
Conclusion: Prolonged antithrombotic therapy for post-procedure repeated in-stent thrombosis may increase the risk of intracranial hemorrhage. Early aggressive surgical treatment including carotid endarterectomy and removal of the stent should be considered in this situation.