Surgical management of acute carotid thrombosis after carotid stenting: A report of three cases

• Published in: Journal of vascular surgery Vol. 42; no. 5; pp. 993 - 996
• Main Authors: Setacci, Carlo, de Donato, Gianmarco, Setacci, Francesco, Chisci, Emiliano, Cappelli, Alessandro, Pieraccini, Massimo, Castriota, Fausto, Cremonesi, Alberto
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2005; Elsevier
• Subjects: Acute Disease; Aged; Aged, 80 and over; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Cardiology. Vascular system; Carotid Artery Thrombosis - etiology; Carotid Artery Thrombosis - surgery; Carotid Artery, Internal; Carotid Stenosis - surgery; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endarterectomy, Carotid; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - surgery; Humans; Male; Medical sciences; Neurology; Reoperation; Stents - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular diseases and vascular malformations of the nervous system; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular disease; Case study; Clinical management; Carotid; Surgery; Cardiovascular disease; Thrombosis
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2005.06.031

We report three cases of symptomatic acute carotid thrombosis occurring after carotid artery stenting (CAS). A patient presented with crescendo transient ischemic attacks on the second day after CAS. Ultrasound images demonstrated incomplete in-stent thrombosis due to plaque protrusion. The urgent surgical procedure consisted of stent removal and carotid thromboendarterectomy. A case of complete thrombosis of a carotid stent occurred 4 days after implantation in a patient with essential thrombocythemia diagnosed by chance. The surgical strategy included stent removal and carotid thromboendarterectomy. Cardiac multiple embolisms in a patient with chronic atrial fibrillation caused concomitant leg ischemia and acute carotid stent occlusion 2 hours after CAS. Cerebral reperfusion was established by embolectomy, without removing the stent. At the same time, the right leg ischemia was resolved by a thromboembolectomy with a Fogarty catheter. These three cases demonstrate that acute thrombosis after carotid stenting can be managed successfully with emergent surgical intervention. Thromboendarterectomy with stent removal or in selected cases, simple thromboembolectomy, can minimize neurologic sequelae in patients suffering from acute post-stenting carotid thrombosis.