In-stent Thrombosis after Carotid Artery Stenting Despite Sufficient Antiplatelet Therapy in a Bladder Cancer Patient

• Published in: Journal of stroke and cerebrovascular diseases Vol. 22; no. 7; pp. 1196 - 1200
• Main Authors: Kanemaru, Kazuya, MD, PhD, Nishiyama, Yoshihisa, MD, PhD, Yoshioka, Hideyuki, MD, PhD, Satoh, Kaneo, PhD, Hashimoto, Koji, MD, Hanihara, Mitsuto, MD, Horikoshi, Toru, MD, PhD, Ozaki, Yukio, MD, PhD, Kinouchi, Hiroyuki, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2013
• Subjects: Aged; Cancer patient; Carcinoma - complications; Cardiovascular; carotid artery stenting; Carotid Stenosis - complications; Carotid Stenosis - surgery; Humans; in-stent thrombosis; Male; Neurology; Platelet Aggregation Inhibitors - therapeutic use; Stents - adverse effects; Thrombosis - etiology; Urinary Bladder Neoplasms - complications; carotid artery stenting; in-stent thrombosis; Cancer patient
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2012.12.015

In-stent thrombosis (IST) after carotid artery stenting (CAS) is a rare but potentially devastating complication. We present a case of early IST after CAS despite sufficient antiplatelet therapy in a patient with bladder cancer. A 77-year-old man under preventive triple antiplatelet therapy underwent CAS without any intra- or periprocedural complications. However, the patient developed a large asymptomatic IST 6 days after CAS. Anticoagulant therapy with argatroban was reintroduced to treat IST concomitant with antiplatelet agents. Subsequently, the IST shrank and disappeared without any thrombotic symptoms. Malignancy is regarded as an acquired thrombophilic condition associated with a significant risk of thrombosis. In the field of coronary stents, cancer is associated with a significant increasing risk of IST. The cause of IST in our case was possibly related in hypercoagulable state because of the patient’s cancer. Attention for IST should be paid in CAS cases with these risk factors, and repeated examination is recommended.