title: Surgical management of acute carotid thrombosis after carotid stenting: a report of three cases.
abstract: We report three cases of symptomatic acute carotid thrombosis occurring after carotid artery stenting (CAS). CASE 1: A patient presented with crescendo transient ischemic attacks on the second day after CAS. Ultrasound images demonstrated incomplete in-stent thrombosis due to plaque protrusion. The urgent surgical procedure consisted of stent removal and carotid thromboendarterectomy. CASE 2: A case of complete thrombosis of a carotid stent occurred 4 days after implantation in a patient with essential thrombocythemia diagnosed by chance. The surgical strategy included stent removal and carotid thromboendarterectomy. CASE 3: Cardiac multiple embolisms in a patient with chronic atrial fibrillation caused concomitant leg ischemia and acute carotid stent occlusion 2 hours after CAS. Cerebral reperfusion was established by embolectomy, without removing the stent. At the same time, the right leg ischemia was resolved by a thromboembolectomy with a Fogarty catheter. These three cases demonstrate that acute thrombosis after carotid stenting can be managed successfully with emergent surgical intervention. Thromboendarterectomy with stent removal or in selected cases, simple thromboembolectomy, can minimize neurologic sequelae in patients suffering from acute post-stenting carotid thrombosis.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Siena, Siena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
authors.forename: Gianmarco
authors.initials: G
authors.lastname: de Donato
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.forename: Emiliano
authors.initials: E
authors.lastname: Chisci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Pieraccini
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D002341:Carotid Artery Thrombosis / Q000209:etiology / Q000601:surgery*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D012086:Reoperation; D015607:Stents / Q000009:adverse effects*