Successful Recanalization Using the Direct Aspiration First Pass Technique for Acute Carotid Stent Thrombosis Following Carotid Artery Stenting

TL;DR

A patient with a blocked carotid stent was successfully treated using a mechanical thrombectomy technique, avoiding further complications.

Contribution

Demonstrates the effectiveness of direct aspiration first pass technique for acute carotid stent thrombosis.

Findings

Mechanical thrombectomy using direct aspiration achieved successful recanalization of the occluded carotid stent.

Post-procedure administration of ozagrel sodium and prasugrel prevented re-occlusion and stenosis.

The patient showed no recurrence of cerebral infarction after the procedure.

Abstract

Acute carotid stent thrombosis is a known serious complication of carotid artery stenting (CAS) with no established standard treatment. Here, we present such a case wherein early recanalization with mechanical thrombectomy proved effective. An 80-year-old man underwent CAS for symptomatic left internal carotid artery stenosis. On postoperative day 4, he developed right hemiparesis and aphasia. Cranial imaging revealed a left cerebral infarction and left carotid stent thrombosis. Mechanical thrombectomy using the direct aspiration first pass technique was performed for the in-stent occlusion, resulting in successful recanalization. Due to a partial contrast filling defect within the stent after recanalization, 80 mg of ozagrel sodium was administered intravenously and prasugrel was delivered via a nasogastric tube. Subsequent angiography showed no re-occlusion or stenosis, and the procedure was completed. No recurrence of cerebral infarction was observed postoperatively, and the patient was transferred to a rehabilitation facility.

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