Case report: Combined acute revascularization in early bilateral carotid stent occlusion
IntroductionThe introduction of a carotid stent involves the use of effective antiplatelet therapy to maintain stent patency. We present a case report of combined acute revascularization in a patient with occlusion in recently introduced stents of both carotid arteries.MethodsThe patient (male, 73 y...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.992685/full |
| _version_ | 1818049137967366144 |
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| author | David Černík Robert Bartoš Jarmila Neradová Nicol Frenštátská Filip Cihlář Štěpánka Brušáková Martin Sameš |
| author_facet | David Černík Robert Bartoš Jarmila Neradová Nicol Frenštátská Filip Cihlář Štěpánka Brušáková Martin Sameš |
| author_sort | David Černík |
| collection | DOAJ |
| description | IntroductionThe introduction of a carotid stent involves the use of effective antiplatelet therapy to maintain stent patency. We present a case report of combined acute revascularization in a patient with occlusion in recently introduced stents of both carotid arteries.MethodsThe patient (male, 73 years) was admitted for stroke recurrence upon discontinuation of antiplatelet therapy. According to the CTA, the closure of implanted stents of both carotid arteries was confirmed. Intravenous thrombolysis and mechanical thrombectomy were performed with complete recanalization of the left carotid stent. At 3 days apart, clinical deterioration was found with progressive stent restenosis. Percutaneous transluminal stent angioplasty, mechanical embolectomy and prolonged low-dose intravenous thrombolysis have been used repeatedly.ResultsWith the impossibility of maintaining the patency of carotid stents even on the maximum drug therapy and despite endovascular procedures, bilateral neurosurgical revascularization of the middle cerebral arteries using ECIC bypasses was successfully performed. Prolonged low-dose intravenous thrombolysis (20 mg recombinant plasminogen aktivator (rTPA)/10 h) has proven to be an acute bridging therapy until surgery.ConclusionEarly occlusion of the carotid stent is a significant complication of endovascular treatment of stenotic arteries. ECIC bypass revascularization of the middle cerebral artery can be a highly effective therapeutic procedure. |
| first_indexed | 2024-12-10T10:32:48Z |
| format | Article |
| id | doaj.art-c18acdbf3ec94e1bb9258de0bf7946cb |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-10T10:32:48Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-c18acdbf3ec94e1bb9258de0bf7946cb2022-12-22T01:52:32ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-09-011310.3389/fneur.2022.992685992685Case report: Combined acute revascularization in early bilateral carotid stent occlusionDavid Černík0Robert Bartoš1Jarmila Neradová2Nicol Frenštátská3Filip Cihlář4Štěpánka Brušáková5Martin Sameš6Comprehensive Stroke Center, Neurology, Masaryk Hospital, Ústí nad Labem, CzechiaDepartment of Neurosurgery, Masaryk Hospital, J. E. Purkinje University, Ústí nad Labem, CzechiaComprehensive Stroke Center, Neurology, Masaryk Hospital, Ústí nad Labem, CzechiaComprehensive Stroke Center, Neurology, Masaryk Hospital, Ústí nad Labem, CzechiaDepartment of Radiology, Masaryk Hospital, J. E. Purkinje University, Ústí nad Labem, CzechiaComprehensive Stroke Center, Neurology, Masaryk Hospital, Ústí nad Labem, CzechiaDepartment of Neurosurgery, Masaryk Hospital, J. E. Purkinje University, Ústí nad Labem, CzechiaIntroductionThe introduction of a carotid stent involves the use of effective antiplatelet therapy to maintain stent patency. We present a case report of combined acute revascularization in a patient with occlusion in recently introduced stents of both carotid arteries.MethodsThe patient (male, 73 years) was admitted for stroke recurrence upon discontinuation of antiplatelet therapy. According to the CTA, the closure of implanted stents of both carotid arteries was confirmed. Intravenous thrombolysis and mechanical thrombectomy were performed with complete recanalization of the left carotid stent. At 3 days apart, clinical deterioration was found with progressive stent restenosis. Percutaneous transluminal stent angioplasty, mechanical embolectomy and prolonged low-dose intravenous thrombolysis have been used repeatedly.ResultsWith the impossibility of maintaining the patency of carotid stents even on the maximum drug therapy and despite endovascular procedures, bilateral neurosurgical revascularization of the middle cerebral arteries using ECIC bypasses was successfully performed. Prolonged low-dose intravenous thrombolysis (20 mg recombinant plasminogen aktivator (rTPA)/10 h) has proven to be an acute bridging therapy until surgery.ConclusionEarly occlusion of the carotid stent is a significant complication of endovascular treatment of stenotic arteries. ECIC bypass revascularization of the middle cerebral artery can be a highly effective therapeutic procedure.https://www.frontiersin.org/articles/10.3389/fneur.2022.992685/fullECIC bypassprolonged low-dose intravenous thrombolysiscarotid stent occlusionstrokemechanical thrombectomy |
| spellingShingle | David Černík Robert Bartoš Jarmila Neradová Nicol Frenštátská Filip Cihlář Štěpánka Brušáková Martin Sameš Case report: Combined acute revascularization in early bilateral carotid stent occlusion Frontiers in Neurology ECIC bypass prolonged low-dose intravenous thrombolysis carotid stent occlusion stroke mechanical thrombectomy |
| title | Case report: Combined acute revascularization in early bilateral carotid stent occlusion |
| title_full | Case report: Combined acute revascularization in early bilateral carotid stent occlusion |
| title_fullStr | Case report: Combined acute revascularization in early bilateral carotid stent occlusion |
| title_full_unstemmed | Case report: Combined acute revascularization in early bilateral carotid stent occlusion |
| title_short | Case report: Combined acute revascularization in early bilateral carotid stent occlusion |
| title_sort | case report combined acute revascularization in early bilateral carotid stent occlusion |
| topic | ECIC bypass prolonged low-dose intravenous thrombolysis carotid stent occlusion stroke mechanical thrombectomy |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.992685/full |
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