Prasugrel is effective for in-stent thrombosis after carotid artery stenting

Abstract

We report the case of a patient with in-stent thrombosis who was effectively treated by administration of prasugrel. Although a 70-year-old man with symptomatic ICA stenosis was treated with CEA one year ago, restenosis was seen. He did not have clopidogrel resistance; hence, he underwent CAS with clopidogrel 75 mg/day and aspirin 100 mg/day. On the fifth day after the stent placement, the patient showed sudden onset of right hemiparesis and aphasia. Emergency angiography showed in-stent thrombosis. An additional stent was placed. Aspirin was changed to cilostazol 200 mg/day. Heparin and argatroban were administered. However, on the fifth day after the CAS retreatment, the patient showed sudden onset of recurrence of right hemiparesis. Emergency angiography showed in-stent thrombosis. We administered prasugrel 20 mg orally. The thrombus started disappearing after 10 minutes and had disappeared after 2 days. Prasugrel may be one of the treatment options for in-stent thrombosis.