Transient ischemic attack due to early carotid stent thrombosis: successful rescue with rheolytic thrombectomy and systemic abciximab.
OBJECTIVE
To describe a successful neurorescue technique in a patient with generalized seizures followed by hemiparesis immediately after carotid artery stenting (CAS) for a postsurgical restenosis.


METHODS
A 65-year-old man with a symptomatic recurrent high-grade carotid stenosis after carotid endarterectomy was treated with CAS. The procedure was complicated by sudden transient ischemic attack caused by acute carotid stent thrombosis with clot propagation into the cerebral circulation. Percutaneous mechanical thrombectomy was performed with adjunctive infusion of intravenous abciximab, resulting in complete thrombus dissolution and resolution of neurological symptoms.


CONCLUSIONS
Access to a mechanical thrombectomy device was essential for rapid thrombus extraction, and adjunctive abciximab aided in residual clot dissolution. As a result of this combined method of clot removal, a disastrous outcome was averted.
Bush
Ruth L
RL
Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and The Methodist Hospital, Houston, Texas 77030, USA. rbush@bcm.tmc.edu
Bhama
Jay K
JK
Lin
Peter H
PH
Lumsden
Alan B
AB
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D002341:Carotid Artery Thrombosis / Q000150:complications* / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000628:therapy*; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D012074:Remission Induction; D015607:Stents; D017131:Thrombectomy / Q000379:methods; D013997:Time Factors
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab