Zhang Huijun, Yan Qian Feng, Shen Hua, Jin Wei, Zhang Zhichen, Miao Zhongrong, Zhang Yun, Sun Xuan
Department of Neurology, Tong Ren Hospital Shanghai Jiaotong University School of Medicin.
Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University.
Int J Surg Case Rep. 2021 Aug;85:106288. doi: 10.1016/j.ijscr.2021.106288. Epub 2021 Aug 6.
We report a rare case of subacute recurrent in-stent thrombosis after vertebral artery stenting of the left intracranial segment.
A 56-year-old man presented with V4 segment severe stenosis of the left vertebral artery. Stent (Apollo, 2.5 mm × 8 mm) implantation was performed for severe stenosis of the left vertebral artery. Approximately 48 h after operation, the patient developed dizziness and drowsiness. DSA showed stent thrombosis, which was treated by PTAS (Apollo, 2.5 mm × 13 mm), and the preoperative symptoms resolved. Two days later, symptoms of posterior circulation ischemia reappeared, DSA showed recurrence of stent thrombosis and CYP2C19 genotypic analysis showed intermediate metabolizers. Revision PTAS (Enterprise, 4.5 mm × 28 mm) was performed followed by administration of Ticagrelor instead of tirofiban. The patient showed good neurological outcomes. CTA performed both one week and four months after the operation showed that the blood flow of the left vertebral artery was unobstructed.
Endovascular therapy is an alternative treatment for severe intracranial vascular stenosis, and reocclusion is one of the serious complications.
our case report highlights that recurrent in-stent thrombosis maybe be caused by inadequate preoperative assessment and unsuitable therapeutic drug selection for the stents.
我们报告一例左颅内段椎动脉支架置入术后亚急性复发性支架内血栓形成的罕见病例。
一名56岁男性，因左椎动脉V4段严重狭窄就诊。对左椎动脉严重狭窄进行了支架（阿波罗，2.5毫米×8毫米）植入术。术后约48小时，患者出现头晕和嗜睡。数字减影血管造影（DSA）显示支架血栓形成，通过经皮腔内血管成形术（PTAS，阿波罗，2.5毫米×13毫米）进行治疗，术前症状缓解。两天后，后循环缺血症状再次出现，DSA显示支架血栓复发，细胞色素P450 2C19基因分型分析显示为中间代谢型。进行了翻修PTAS（恩多泰，4.5毫米×28毫米），随后给予替格瑞洛而非替罗非班。患者神经功能恢复良好。术后一周和四个月进行的CTA显示左椎动脉血流通畅。
血管内治疗是重度颅内血管狭窄的一种替代治疗方法，再闭塞是严重并发症之一。
我们的病例报告强调，复发性支架内血栓形成可能是由于术前评估不足以及针对支架选择了不合适的治疗药物所致。
