Segawa Masafumi, Inoue Tomohiro, Tsunoda Sho, Kanamaru Takuya, Okubo Seiji
Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan.
Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan.
Surg Neurol Int. 2023 Jan 27;14:25. doi: 10.25259/SNI_1021_2022. eCollection 2023.
Acute carotid stent thrombosis (ACST) is a rare but devastating complication for carotid artery stenting (CAS). That requires early diagnosis and immediate treatment. Although administration of drugs or endovascular treatment is the most widely used approach for patients with ACST, there is no consensus on the standard treatment of this disease.
The present study reports on an 80-year-old female patient with the right internal carotid artery stenosis (ICS) that had been followed up by ultrasonography for 8 years. Although the optimal medical treatment was followed, the patient's right ICS worsened, and the patient was subsequently hospitalized for CAS. On the 12 day after CAS, left paralysis and dysarthria were observed. Head magnetic resonance imaging (MRI) showed acute obstruction of the stent and scattered cerebral infarction in the right cerebral hemisphere caused possibly by the discontinuation of temporary antiplatelet drug therapy as a means to prepare for embolectomy of the femoral artery. Stent removal and carotid endarterectomy (CEA) were selected as the appropriate treatment approach. CEA was performed with the precaution of stent removal and distal embolism, and complete recanalization was obtained. Postoperative head MRI showed no new findings of cerebral infarction, and the patients remained symptom-free after 6 months of postoperative follow-up.
Stent removal with CEA could be an appropriate curative option in some cases with ACST except in patients at high risk of CEA and in the chronic phase after CAS.
急性颈动脉支架血栓形成（ACST）是颈动脉支架置入术（CAS）一种罕见但极具破坏性的并发症。这需要早期诊断和立即治疗。尽管药物治疗或血管内治疗是ACST患者最广泛使用的方法，但对于这种疾病的标准治疗尚无共识。
本研究报告了一名80岁女性患者，其右侧颈内动脉狭窄（ICS）已通过超声检查随访8年。尽管遵循了最佳药物治疗，但患者的右侧ICS病情恶化，随后因CAS住院。CAS术后第12天，观察到左侧肢体瘫痪和构音障碍。头部磁共振成像（MRI）显示支架急性阻塞以及右侧大脑半球散在性脑梗死，可能是由于作为股动脉取栓术准备手段的临时抗血小板药物治疗中断所致。选择取出支架并进行颈动脉内膜切除术（CEA）作为合适的治疗方法。CEA在采取预防支架取出和远端栓塞的措施下进行，并实现了完全再通。术后头部MRI未显示脑梗死新发现，术后6个月随访患者无症状。
对于某些ACST病例，除了CEA高风险患者和CAS慢性期患者外，取出支架并进行CEA可能是一种合适的治疗选择。
