title: Acute Carotid Stent Thrombosis: A Comprehensive Review.
abstract: Acute carotid stent thrombosis (ACST) is a rare complication that can lead to dramatic and catastrophic consequences. A rapid diagnosis and prompt recanalization of the internal carotid artery are needed to minimize the ischemic insult and the reperfusion injury. We reviewed the current literature on this devastating complication of CAS with the intention of investigating the potential causative factors and to define the appropriate management. According to our study discontinuation of antiplatelet therapy, resistance to antiplatelet agents and inherent or acquired thrombotic disorders are the main causes of thrombosis. Technical intraprocedural parameters such as dissection, atheroma prolapse, kinking of the distal part of internal carotid artery and embolic protection device occlusion can also result in early carotid stent thrombosis. Rapid reperfusion ensures an improved neurological outcome and a better prognosis in the short and long term. Thrombolysis, mechanical thrombectomy or thromboaspiration in combination with drug or thrombolytic therapy, surgical therapy and re-angioplasty are treatment options that have been used with encouraging results. In conclusion, optimal perioperative antiplatelet treatment as well as technical considerations regarding the carotid artery stenting plays a determinant role.
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Moulakakis
authors.affiliation: Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece spyrosmylonas@gmail.com.
authors.forename: Spyridon N
authors.initials: SN
authors.lastname: Mylonas
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lazaris
authors.affiliation: Department of Neurology, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kakisis
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Giorgos S
authors.initials: GS
authors.lastname: Sfyroeras
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Antonopoulos
authors.affiliation: Department of Radiology, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Elias N
authors.initials: EN
authors.lastname: Brountzos
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Spyridon N
authors.initials: SN
authors.lastname: Vasdekis
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000209:etiology; D019091:Critical Pathways; D042241:Early Diagnosis; D006801:Humans; D011237:Predictive Value of Tests; D019233:Retreatment; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome
keywords: acute stroke; carotid stenting; stent thrombosis