Acute carotid stent thrombosis: review of the literature and long-term follow-up.

Background: Carotid artery stenting (CAS) is a reasonable alternative to carotid endarterectomy, especially in patients at high risk for surgery. Carotid stent thrombosis can cause thrombembolic events, but fortunately, it is a very rare complication. We present two cases of carotid stent thrombosis and their long-term follow-up.

Case Reports: One patient had severe bilateral carotid stenosis and the other had contralateral carotid occlusion. Both patients were on correct antithrombotic treatment and received balloon expandable stents (bare metal stent and drug-eluting stent). During CAS, large thrombus formed within the stent followed by rapid hemodynamic and neurological alteration. We gave a bolus thrombolytic in the clot, followed by continuous intra-arterial infusion. In one case, we performed additional angioplasty. Repeated angiography showed complete resolution of the thrombus, followed by progressive improvement in the neurological state. At discharge, the patients had no neurological deficits. CT scans revealed no acute ischemic lesions. One patient had in-stent restenosis 3 years later, which was treated with an additional self-expandable stent. The last follow-up was done 4 and 9 years, respectively, from the initial CAS complication. Both patients did not experience any neurological events after the last procedure.

Conclusions: Carotid stent thrombosis is a rare but potentially fatal complication following CAS. Rapid invasive diagnosis and reperfusion should be done to limit cerebral ischemia. The possible causes must be sighted and reperfusion must be started. Despite an initial dramatic course, a rapid reperfusion ensures a complete neurological recovery and a good prognosis in the long term.