2020 Volume 25 Issue 1 Pages 102-110
For asymptomatic lesions of internal carotid artery stenosis, 80% or more of stenosis lesions in the SAPPHIRE study met the carotid artery stenting (CAS) eligibility criteria. Although CAS is well known for thrombosis caused by devices, along with embolisms caused by plaque splashing, acute carotid stent thrombosis (ACST) is a relatively rare complication, and few cases have been reported. Although its incidence rate is 0.5‒0.8%, and there is no established treatment plan, the possibility of CAS causing a distal embolism is high, and must often be dealt with. Stent occlusion can lead to serious complications, especially if the patient is ischemic intolerant. In this case report, we review the treatment results of two cases with stent occlusion that occurred early after CAS, with bibliographical considerations. Both cases involved 75‒year‒old men. They had asymptomatic lesions that progressed to left cervical internal carotid artery stenosis after 6‒9 years, leading to their referral to our department. CAS was conducted under local anesthesia, and the procedures were completed without incident. Case 1: Stent occlusion was observed 5 days after CAS. Although PTA was carried out to reopen the areas of blockage, the patient also experienced a postoperative cerebral infarction, but was discharged with mRS 1. Case 2: Stent occlusion was observed 13 days after CAS. Although PTA was conducted by the Parodi method and reopened, a large amount of the thrombus was found in the internal carotid artery, resulting in thrombus recovery conducted using a Penumbra 5MAX ACE. The patient was discharged with mRS 0, with no postoperative cerebral infarction. Both cases have progressed successfully without restenosis. It is necessary to carefully consider applicable treatments for asymptomatic carotid artery lesions, both for carotid endarterectomy (CEA) and CAS. If surgical therapeutic intervention is conducted with CAS, it is especially necessary to thoroughly carry out intraoperative procedures and perioperative management, paying careful attention to thrombotic complications, while recognizing that rare complications exist, such as stent premature occlusion due to ACST.
