# 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.

## Key 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.