Two Cases of In-stent Thrombosis Treated with Prasugrel Administration: A Case Report

Abstract

Objective: No therapeutic strategy has been established for in-stent thrombosis that occurs during the perioperative period of neuro-intervention. Herein, we report two cases who suffered from in-stent thrombosis and were effectively treated by prasugrel administration.

Case presentations: Case 1: In-stent thrombosis occurred just after stent-assisted coil embolization for an unruptured cerebral aneurysm. The thrombus kept growing during the neuro-intervention procedure despite the infusion of heparin, ozagrel, and argatroban. Next, when prasugrel was administered, the in-stent clot was immediately eradicated.

Case 2: In-stent thrombosis was revealed 5 days after carotid stent placement. The thrombus grew steadily and caused ischemic stroke despite antithrombotic therapies including strict heparinization. Prasugrel was subsequently administered, and the in-stent clot was immediately eradicated. The disappearance of the clot was confirmed by three-dimensional CT angiography (3D-CTA).

Conclusion: These cases demonstrate that prasugrel administration was effective for in-stent thrombosis relevant to neuro-intervention procedures. Prasugrel should be considered for in-stent thrombosis when other therapeutic methods are ineffective.