Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan.
J Stroke Cerebrovasc Dis. 2013 Oct;22(7):1196-200. doi: 10.1016/j.jstrokecerebrovasdis.2012.12.015. Epub 2013 Jul 5.
In-stent thrombosis (IST) after carotid artery stenting (CAS) is a rare but potentially devastating complication. We present a case of early IST after CAS despite sufficient antiplatelet therapy in a patient with bladder cancer. A 77-year-old man under preventive triple antiplatelet therapy underwent CAS without any intra- or periprocedural complications. However, the patient developed a large asymptomatic IST 6 days after CAS. Anticoagulant therapy with argatroban was reintroduced to treat IST concomitant with antiplatelet agents. Subsequently, the IST shrank and disappeared without any thrombotic symptoms. Malignancy is regarded as an acquired thrombophilic condition associated with a significant risk of thrombosis. In the field of coronary stents, cancer is associated with a significant increasing risk of IST. The cause of IST in our case was possibly related in hypercoagulable state because of the patient's cancer. Attention for IST should be paid in CAS cases with these risk factors, and repeated examination is recommended.
支架内血栓形成（IST）是颈动脉支架置入术（CAS）后一种罕见但潜在危险的并发症。我们报告了一例膀胱癌患者在充分抗血小板治疗的情况下，CAS 后早期发生 IST 的病例。一名 77 岁男性患者接受预防性三联抗血小板治疗后行 CAS，术中无任何并发症。然而，患者在 CAS 后 6 天发生了无症状的大 IST。重新引入抗凝剂阿加曲班联合抗血小板药物治疗 IST。随后，IST 缩小并消失，没有任何血栓症状。恶性肿瘤被认为是一种获得性血栓形成倾向状态，与血栓形成的风险显著增加有关。在冠状动脉支架领域，癌症与 IST 风险显著增加有关。我们病例中 IST 的原因可能与患者的癌症导致的高凝状态有关。在存在这些危险因素的 CAS 病例中应注意 IST，并建议进行重复检查。
