ACUTE CAROTID STENT THROMBOSIS – A RARE CLINICAL ENTITY?
DOI:
https://doi.org/10.48750/acv.173Keywords:
Carotid stenosis [MeSH Terms], Carotid Artery Diseases [MeSH Terms], Stents [MeSH Terms], Carotid Artery Thrombosis [MeSH Terms]Abstract
Introduction: Acute carotid stent thrombosis (ACST), defined according to the Academic Research Consortium as occurring in the first 24 hours after the procedure, is described as an exceedingly rare complication of CAS but it can lead to catastrophic neurologic consequences. The European Society for Vascular Surgery updated guidelines state thrombolysis and intravenous abciximab may be effective, but provide no specific recommendations.
Given the lack of data concerning the optimal management, the purpose of this review was to evaluate the current literature and report on ACST aetiology and management strategies.
Methods: Literature review was performed in the MEDLINE database.
Results: No data on ACST is evident in large randomized controlled trials. ACST incidence rate ranges from 0.5-0.8%, reaching as high as 33% in acute-setting.
Considering aetiology, it can be subdivided into 2 main groups: systemic causes and technical complications. In the first antiplatelet non-compliance/resistance were the most reported while in the latter carotid artery dissection and plaque protrusion were the most common causes. Also, dual layer stents were associated with greater risk for ACST
There are three main approaches for ACST: pharmacologic, endovascular and surgical. Pharmacologic management included anticoagulation, thrombolysis and facilitated thrombolysis. A role for thrombolysis and facilitated thrombolysis is still to be determined. Endovascular treatment was the most common approach to intraprocedural ACST: mechanical thrombectomy with or without concomitant facilitated thrombolysis. Surgical options included carotid endarterectomy with stent explantation which was a bail-out after failed endovascular treatment with excellent recanalization rates. In asymptomatic ACST conservative management with anticoagulation was unanimous.
Discussion: As a conclusion, ACST is probably an underestimated clinical entity associated with multiple risk factors. Decision on the best approach depends if ACST occurs intraprocedural or afterwards, on the development of neurologic status deterioration and on centre´s experience. Additional studies must be undertaken to better define optimal management.
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References
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15. Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. The Lancet Neurology. 2008;7(10):893-902.
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17. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet (London, England). 2001;357(9270):1729-37.
18. Moulakakis KG, Mylonas SN, Lazaris A, Tsivgoulis G, Kakisis J, Sfyroeras GS, et al. Acute Carotid Stent Thrombosis: A Comprehensive Review. Vascular and endovascular surgery. 2016;50(7):511-21.
19. Moulakakis KG, Kakisis J, Tsivgoulis G, Zymvragoudakis V, Spiliopoulos S, Lazaris A, et al. Acute Early Carotid Stent Thrombosis: A Case Series. Ann Vasc Surg. 2017;45:69-78.(doi):10.1016/j.avsg.2017.04.039. Epub May 5.
20. Koklu E, Yuksel IO, Bayar N, Arslan S. Is Acute Carotid Artery Stent Thrombosis an Avoidable Complication? J Stroke Cerebrovasc Dis. 2015;24(10):2219-22. doi: 10.1016/j.jstrokecerebrovasdis.2015.05.029. Epub Aug 21.
21. Setacci C, de Donato G, Setacci F, Chisci E, Cappelli A, Pieraccini M, et al. Surgical management of acute carotid thrombosis after carotid stenting: a report of three cases. J Vasc Surg. 2005;42(5):993-6. doi: 10.1016/j.jvs.2005.06.031.
22. Deguchi I, Hayashi T, Neki H, Yamane F, Ishihara S, Tanahashi N, et al. Carotid Artery Stenting for Acute Ischemic Stroke Patients after Intravenous Recombinant Tissue Plasminogen Activator Treatment. Intern Med. 2016;55(19):2869-72. doi: 10.169/internalmedicine.55.7038. Epub 2016 Oct 1.
23. Steglich-Arnholm H, Holtmannspotter M, Kondziella D, Wagner A, Stavngaard T, Cronqvist ME, et al. Thrombectomy assisted by carotid stenting in acute ischemic stroke management: benefits and harms. Journal of neurology. 2015;262(12):2668-75.
24. Yilmaz U, Korner H, Muhl-Benninghaus R, Simgen A, Kraus C, Walter S, et al. Acute Occlusions of Dual-Layer Carotid Stents After Endovascular Emergency Treatment of Tandem Lesions. Stroke. 2017;48(8):2171-5.
25. Koklu E, Arslan S, Yuksel IO, Bayar N, Koc P. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance. Cardiovasc Intervent Radiol. 2015;38(4):1011-4. doi: 10.07/s00270-014-0959-1. Epub 2014 Aug 13.
26. Fifi JT, Brockington C, Narang J, Leesch W, Ewing SL, Bennet H, et al. Clopidogrel resistance is associated with thromboembolic complications in patients undergoing neurovascular stenting. AJNR American journal of neuroradiology. 2013;34(4):716-20.
27. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Kardiol Pol. 2017;75(12):1217-99.
28. Munich S, Moftakhar R, Lopes D. Recanalization of acute carotid stent occlusion using Penumbra 4Max aspiration catheter: technical report and review of rescue strategies for acute carotid stent occlusion. J Neurointerv Surg. 2014;6(8):e42. doi: 10.1136/neurintsurg-2013-010706.rep. Epub 2013 Oct 22.
29. Kotsugi M, Takayama K, Myouchin K, Wada T, Nakagawa I, Nakagawa H, et al. Carotid Artery Stenting: Investigation of Plaque Protrusion Incidence and Prognosis. JACC Cardiovasc Interv. 2017;10(8):824-31.
30. Bosiers M, de Donato G, Deloose K, Verbist J, Peeters P, Castriota F, et al. Does free cell area influence the outcome in carotid artery stenting? European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2007;33(2):135-41; discussion 42-3.
31. Kanemaru K, Nishiyama Y, Yoshioka H, Satoh K, Hashimoto K, Hanihara M, et al. In-stent thrombosis after carotid artery stenting despite sufficient antiplatelet therapy in a bladder cancer patient. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22(7):1196-200.
32. Tong FC, Cloft HJ, Joseph GJ, Samuels OB, Dion JE. Abciximab rescue in acute carotid stent thrombosis. AJNR Am J Neuroradiol. 2000;21(9):1750-2.
33. Steiner-Boker S, Cejna M, Nasel C, Minar E, Kopp CW. Successful revascularization of acute carotid stent thrombosis by facilitated thrombolysis. AJNR Am J Neuroradiol. 2004;25(8):1411-3.
34. Kim SH, Qureshi AI, Levy EI, Hanel RA, Siddiqui AM, Hopkins LN. Emergency stent placement for symptomatic acute carotid artery occlusion after endarterectomy. Case report. J Neurosurg. 2004;101(1):151-3. doi: 10.3171/jns.2004.101.1.0151.
35. Dhall A, Malani SK, Chadha DS. Thrombosuction for procedural acute thrombosis during high-risk carotid angioplasty--a case report. The Journal of invasive cardiology. 2010;22(8):E144-6.
36. Choi JY, Lee JI, Lee TH, Sung SM, Cho HJ, Ko JK. Emergent Recanalization with Stenting for Acute Stroke due to Athero-Thrombotic Occlusion of the Cervical Internal Carotid Artery : A Single Center Experience. Journal of Korean Neurosurgical Society. 2014;55(6):313-20.
37. Iancu A, Grosz C, Lazar A. Acute carotid stent thrombosis: review of the literature and long-term follow-up. Cardiovasc Revasc Med. 2010;11(2):110-3. doi: 10.1016/j.carrev.2009.02.008.
2. Writing G, Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, et al. Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2018;55(1):3-81.
3. Nallamothu BK, Gurm HS, Ting HH, Goodney PP, Rogers MA, Curtis JP, et al. Operator experience and carotid stenting outcomes in Medicare beneficiaries. Jama. 2011;306(12):1338-43.
4. Moulakakis KG, Mylonas SN, Lazaris A, Tsivgoulis G, Kakisis J, Sfyroeras GS, et al. Acute Carotid Stent Thrombosis: A Comprehensive Review. Vasc Endovascular Surg. 2016;50(7):511-21. doi: 10.1177/1538574416665986. Epub 2016 Sep 19.
5. Xiromeritis K, Dalainas I, Stamatakos M, Katsikas V, Martinakis V, Stamatelopoulos K, et al. Acute carotid stent thrombosis after carotid artery stenting. Eur Rev Med Pharmacol Sci. 2012;16(3):355-62.
6. Watarai H, Kaku Y, Yamada M, Kokuzawa J, Tanaka T, Andoh T, et al. Follow-up study on in-stent thrombosis after carotid stenting using multidetector CT angiography. Neuroradiology. 2009;51(4):243-51. doi: 10.1007/s00234-009-0498-7. Epub 2009 Jan 27.
7. Masuo O, Terada T, Matsuda Y, Ogura M, Tsumoto T, Yamaga H, et al. Successful recanalization by in-stent percutaneous transluminal angioplasty with distal protection for acute carotid stent thrombosis. Neurol Med Chir (Tokyo). 2006;46(10):495-9.
8. Mannheim D, Karmeli R. A prospective randomized trial comparing endarterectomy to stenting in severe asymptomatic carotid stenosis. The Journal of cardiovascular surgery. 2017;58(6):814-7.
9. Eckstein HH, Reiff T, Ringleb P, Jansen O, Mansmann U, Hacke W, et al. SPACE-2: A Missed Opportunity to Compare Carotid Endarterectomy, Carotid Stenting, and Best Medical Treatment in Patients with Asymptomatic Carotid Stenoses. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2016;51(6):761-5.
10. Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC, et al. Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. The New England journal of medicine. 2016;374(11):1011-20.
11. Silver FL, Mackey A, Clark WM, Brooks W, Timaran CH, Chiu D, et al. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke. 2011;42(3):675-80.
12. International Carotid Stenting Study i, Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet (London, England). 2010;375(9719):985-97.
13. Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. The New England journal of medicine. 2008;358(15):1572-9.
14. Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. The Lancet Neurology. 2008;7(10):885-92.
15. Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. The Lancet Neurology. 2008;7(10):893-902.
16. Brooks WH, McClure RR, Jones MR, Coleman TL, Breathitt L. Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery. 2004;54(2):318-24; discussion 24-5.
17. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet (London, England). 2001;357(9270):1729-37.
18. Moulakakis KG, Mylonas SN, Lazaris A, Tsivgoulis G, Kakisis J, Sfyroeras GS, et al. Acute Carotid Stent Thrombosis: A Comprehensive Review. Vascular and endovascular surgery. 2016;50(7):511-21.
19. Moulakakis KG, Kakisis J, Tsivgoulis G, Zymvragoudakis V, Spiliopoulos S, Lazaris A, et al. Acute Early Carotid Stent Thrombosis: A Case Series. Ann Vasc Surg. 2017;45:69-78.(doi):10.1016/j.avsg.2017.04.039. Epub May 5.
20. Koklu E, Yuksel IO, Bayar N, Arslan S. Is Acute Carotid Artery Stent Thrombosis an Avoidable Complication? J Stroke Cerebrovasc Dis. 2015;24(10):2219-22. doi: 10.1016/j.jstrokecerebrovasdis.2015.05.029. Epub Aug 21.
21. Setacci C, de Donato G, Setacci F, Chisci E, Cappelli A, Pieraccini M, et al. Surgical management of acute carotid thrombosis after carotid stenting: a report of three cases. J Vasc Surg. 2005;42(5):993-6. doi: 10.1016/j.jvs.2005.06.031.
22. Deguchi I, Hayashi T, Neki H, Yamane F, Ishihara S, Tanahashi N, et al. Carotid Artery Stenting for Acute Ischemic Stroke Patients after Intravenous Recombinant Tissue Plasminogen Activator Treatment. Intern Med. 2016;55(19):2869-72. doi: 10.169/internalmedicine.55.7038. Epub 2016 Oct 1.
23. Steglich-Arnholm H, Holtmannspotter M, Kondziella D, Wagner A, Stavngaard T, Cronqvist ME, et al. Thrombectomy assisted by carotid stenting in acute ischemic stroke management: benefits and harms. Journal of neurology. 2015;262(12):2668-75.
24. Yilmaz U, Korner H, Muhl-Benninghaus R, Simgen A, Kraus C, Walter S, et al. Acute Occlusions of Dual-Layer Carotid Stents After Endovascular Emergency Treatment of Tandem Lesions. Stroke. 2017;48(8):2171-5.
25. Koklu E, Arslan S, Yuksel IO, Bayar N, Koc P. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance. Cardiovasc Intervent Radiol. 2015;38(4):1011-4. doi: 10.07/s00270-014-0959-1. Epub 2014 Aug 13.
26. Fifi JT, Brockington C, Narang J, Leesch W, Ewing SL, Bennet H, et al. Clopidogrel resistance is associated with thromboembolic complications in patients undergoing neurovascular stenting. AJNR American journal of neuroradiology. 2013;34(4):716-20.
27. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Kardiol Pol. 2017;75(12):1217-99.
28. Munich S, Moftakhar R, Lopes D. Recanalization of acute carotid stent occlusion using Penumbra 4Max aspiration catheter: technical report and review of rescue strategies for acute carotid stent occlusion. J Neurointerv Surg. 2014;6(8):e42. doi: 10.1136/neurintsurg-2013-010706.rep. Epub 2013 Oct 22.
29. Kotsugi M, Takayama K, Myouchin K, Wada T, Nakagawa I, Nakagawa H, et al. Carotid Artery Stenting: Investigation of Plaque Protrusion Incidence and Prognosis. JACC Cardiovasc Interv. 2017;10(8):824-31.
30. Bosiers M, de Donato G, Deloose K, Verbist J, Peeters P, Castriota F, et al. Does free cell area influence the outcome in carotid artery stenting? European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2007;33(2):135-41; discussion 42-3.
31. Kanemaru K, Nishiyama Y, Yoshioka H, Satoh K, Hashimoto K, Hanihara M, et al. In-stent thrombosis after carotid artery stenting despite sufficient antiplatelet therapy in a bladder cancer patient. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22(7):1196-200.
32. Tong FC, Cloft HJ, Joseph GJ, Samuels OB, Dion JE. Abciximab rescue in acute carotid stent thrombosis. AJNR Am J Neuroradiol. 2000;21(9):1750-2.
33. Steiner-Boker S, Cejna M, Nasel C, Minar E, Kopp CW. Successful revascularization of acute carotid stent thrombosis by facilitated thrombolysis. AJNR Am J Neuroradiol. 2004;25(8):1411-3.
34. Kim SH, Qureshi AI, Levy EI, Hanel RA, Siddiqui AM, Hopkins LN. Emergency stent placement for symptomatic acute carotid artery occlusion after endarterectomy. Case report. J Neurosurg. 2004;101(1):151-3. doi: 10.3171/jns.2004.101.1.0151.
35. Dhall A, Malani SK, Chadha DS. Thrombosuction for procedural acute thrombosis during high-risk carotid angioplasty--a case report. The Journal of invasive cardiology. 2010;22(8):E144-6.
36. Choi JY, Lee JI, Lee TH, Sung SM, Cho HJ, Ko JK. Emergent Recanalization with Stenting for Acute Stroke due to Athero-Thrombotic Occlusion of the Cervical Internal Carotid Artery : A Single Center Experience. Journal of Korean Neurosurgical Society. 2014;55(6):313-20.
37. Iancu A, Grosz C, Lazar A. Acute carotid stent thrombosis: review of the literature and long-term follow-up. Cardiovasc Revasc Med. 2010;11(2):110-3. doi: 10.1016/j.carrev.2009.02.008.
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2019-05-15
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Coelho A, Lobo M, Nogueira C, Campos J, Augusto R, Coelho N, Semiao AC, Ribeiro JP, Canedo A. ACUTE CAROTID STENT THROMBOSIS – A RARE CLINICAL ENTITY?. Angiol Cir Vasc [Internet]. 2019 May 15 [cited 2024 Dec. 28];14(4):333-8. Available from: https://acvjournal.com/index.php/acv/article/view/173
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