Moulakakis Konstantinos G, Kakisis John, Tsivgoulis Georgios, Zymvragoudakis Vasilis, Spiliopoulos Stavros, Lazaris Andreas, Sfyroeras Giorgos S, Mylonas Spyridon N, Vasdekis Spyridon N, Geroulakos George, Brountzos Elias N
Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
Ann Vasc Surg. 2017 Nov;45:69-78. doi: 10.1016/j.avsg.2017.04.039. Epub 2017 May 5.
Acute early carotid stent thrombosis (AcuteCST) is a rare complication after carotid artery stenting (CAS). The purpose of this retrospective study was to investigate the incidence, causes, and optimal management of AcuteCST.
Medical records of all patients undergoing CAS between 2008 and 2016 were retrospectively reviewed. The time of thrombosis, grade of stenosis, lesion side, preprocedural and postprocedural anticoagulants, causes, symptoms, treatment, recanalization, and outcome were reviewed.
Overall, 674 patients were treated with CAS. Four cases of AcuteCST were identified (0.59%). In the first patient, the stent thrombosis was attributed to dissection caused by filter deployment within a distal internal carotid artery with 360° coiling. Notably, in 3 of the 4 cases of thrombosis a second overlapping stent had been deployed. In total, 41 patients of the cohort under investigation underwent overlapping stent deployment. The use of a second overlapping stent as a bail-out procedure due to dissection or malposition or due to long lesions was correlated with increased rate of thrombosis (3/41 [7.3%] vs. 1/633 [0.002%]). In 2 patients, carotid stents were thrombosed within 2 hr of the procedure. Endovascular thrombus aspiration and subsequent eversion carotid endarterectomy with stent explantation in the first patient and intrathrombus urokinase administration with thromboaspiration and additional stent placement in the second patient were followed. In the other 2 patients having their carotid stents thrombosed 3 and 4 days after the procedure, treatment with low weight molecular heparin and antiplatelet regimens was followed.
The use of overlapping stents in the carotid artery is a predisposing factor for AcuteCST. Prognostic factors of this potentially devastating complication are the initial clinical presentation expressing the grade of ischemic brain damage, the accurate and timely recognition of the thrombosis, and the prompt restoration of oxygenated blood flow into the viable tissue at risk of infarction.
急性早期颈动脉支架血栓形成（急性颈动脉支架血栓形成，AcuteCST）是颈动脉支架置入术（CAS）后一种罕见的并发症。本回顾性研究的目的是调查急性颈动脉支架血栓形成的发生率、病因及最佳处理方法。
回顾性分析2008年至2016年间所有接受CAS治疗患者的病历。对血栓形成时间、狭窄程度、病变部位、术前和术后抗凝剂使用情况、病因、症状、治疗方法、再通情况及预后进行分析。
总体而言，674例患者接受了CAS治疗。共发现4例急性颈动脉支架血栓形成（0.59%）。第一例患者的支架血栓形成归因于在颈内动脉远端展开过滤器时导致的夹层伴360°盘绕。值得注意的是，4例血栓形成患者中有3例置入了第二个重叠支架。在本研究队列中，共有41例患者接受了重叠支架置入。因夹层、位置不当或病变较长而使用第二个重叠支架作为补救措施与血栓形成率增加相关（41例中的3例[7.3%]对比633例中的1例[0.002%]）。2例患者在术后2小时内颈动脉支架发生血栓形成。对第一例患者进行了血管内血栓抽吸，随后行外翻式颈动脉内膜切除术并取出支架；对第二例患者进行了血栓内尿激酶给药、血栓抽吸并额外置入支架。另外2例患者在术后3天和4天颈动脉支架发生血栓形成，随后采用低分子量肝素和抗血小板治疗方案。
在颈动脉使用重叠支架是急性颈动脉支架血栓形成的一个诱发因素。这种潜在毁灭性并发症的预后因素包括表达缺血性脑损伤程度的初始临床表现、对血栓形成的准确及时识别以及迅速恢复向有梗死风险的存活组织内的氧合血流。
