title: Hyperacute Carotid Stent Thrombosis During Emergent Revascularization Treated with Intraarterial Eptifibatide After Systemic Administration of Recombinant Tissue Plasminogen Activator.
abstract: A 57-year-old woman with National Institutes of Health Stroke Scale (NIHSS) score of 26 was found to have an acute left carotid occlusion with tandem left M1 thrombus within 1.5 hours of symptom onset. After no neurologic improvement following standard-dose intravenous (IV) recombinant tissue plasminogen activator (rtPA), emergent neuroendovascular revascularization with carotid stenting and intracranial thrombectomy were performed under conscious sedation. Thrombolysis in myocardial infarction (TIMI)-3 flow restoration and symptom resolution were achieved postprocedure; however, complete carotid stent thrombosis was noted on final angiographic runs (25 minutes later), correlating with neurologic decline. Rapid administration of an intraarterial (IA) bolus dose of eptifibatide resulted in TIMI-3 flow restoration, with neurologic improvement. The patient was discharged three days postrevascularization on dual antiplatelet therapy with an NIHSS score of 1. Intraarterial (IA) eptifibatide can be an effective option for acute stent occlusion during emergent neuroendovascular revascularization after IV rtPA administration.
  
  
  BACKGROUND
  CLEARCombined approach to lysis utilizing eptifibatide and RtPACTcomputed tomographicFrFrenchGPglycoproteinIAintraarterialICAinternal carotid arteryIVintravenousMCAmiddle cerebral arteryNIHSSNational Institutes of Health Stroke ScalertPArecombinant tissue plasminogen activatorTIMIthrombolysis in myocardial infarction.
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
authors: Grant C
authors: GC
authors: Sorkin
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
authors: Travis M
authors: TM
authors: Dumont
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
authors: Maxim
authors: M
authors: Mokin
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
authors: Jorge L
authors: JL
authors: Eller
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
authors: Sabareesh K
authors: SK
authors: Natarajan
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Toshiba Stroke and Vascular Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
authors: Elad I
authors: EI
authors: Levy
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Toshiba Stroke and Vascular Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
authors: Adnan H
authors: AH
authors: Siddiqui
keywords: carotid stent thrombosis; intraarterial eptifibatide; intravenous recombinant tissue; plasminogen activator