Fifty minutes following implantation of a right internal carotid artery stent, left lower extremity paresis developed in a patient despite use of heparin, clopidogrel and aspirin. Immediate angiograms revealed partially thrombosed carotid stent, then tirofiban (a glycoprotein IIb-IIIa receptor inhibitor) was administered intraarterially into the stent. After 15 minutes, complete resolution of the thrombus was detected on repeat angiography. The patient had recovered completely at 30-day follow-up.
The EPILOG Investigators: Platelet glycoprotein IIb-IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med336: 1689–1696, 1997.
2.
TongFCCloftHJJosephGJ: Abciximab rescue in acute carotid stent thrombosis. Am J Neuroradiol21: 1750–1752, 2000.
3.
BushRLBharmaJKLinPH: Transient ischemic attack due to early carotid stent thrombosis: Successful rescue with rheolytic thrombectomy and systemic abciximab. J Endovasc Ther10: 870–874, 2003.
4.
KittusamyPKKoenigsbergRAMcCormickDJ: Abciximab for the treatment of acute distal embolization associated with internal carotid artery angioplasty. Catheter Cardiovasc Interv54: 221–233, 2001.
5.
HoDSWangYChuiM: Intracarotid abciximab injection to abort impending ischemic stroke during carotid angioplasty. Cerebrovasc Dis11: 300–304, 2001.
6.
Steiner-BokerSCejnaMNaselC: Successful revascularization of acute carotid stent thrombosis by facilitated thrombolysis. Am J Neuroradiol25: 1411–1413, 2004.
7.
RoubinGSYadavSIyerSS: Carotid stent-supported angioplasty: A neurovascular intervention to prevent stroke. Am J Cardiol78: 8–12, 1996.
8.
DiethrichEBNdiayeMReidDB: Stenting in the carotid artery: Initial experience in 110 patients. J Endovasc Surg3: 42–62, 1996.
9.
LiuMWVoorheesWDAgrawalS: Stratification of the risk of thrombosis after intracoronary stenting for threatened or acute closure complicating coronary balloon angioplasty: A Cook registry study. Am Heart J130: 8–13, 1995.
10.
KornowskiRHongMKSaucedoJ: Procedural results and long-term clinical outcomes following coronary stenting in perimyocardial infarction syndromes. Am J Cardiol82: 1163–1167, 1998.
11.
JeongMHOwenWGStaabME: Porcine model of stent thrombosis: Platelets are the primary component of acute stent closure. Catheter Cardiovasc Diagn38: 38–43, 1996.
12.
KapadiaSRBajzerCTZiadaKM: Initial experience of platelet glycoprotein IIb/IIIa inhibition with abciximab during carotid stenting: A safe and effective adjunctive therapy. Stroke32: 2328–2332, 2001.
13.
SchneidermanJMoragBGerniakA: Abciximab in carotid stenting for postsurgical carotid restenosis: Intermediate results. J Endovasc Ther7: 263–272, 2000.
14.
HofmannRKerschnerKSteinwenderC: Abciximab bolus injection does not reduce cerebral ischemic complications of elective carotid artery stenting: A randomized study. Stroke33: 725–727, 2002.
15.
WallaceRCFurlanAJMoliternoDJ: Basilar artery rethrombosis: Successful treatment with platelet glycoprotein IIb/IIIa receptor inhibitor. Am J Neuroradiol18: 1257–1260, 1997.
16.
LempertTEMalekAMHalbachVV: Rescue treatment of acute parent vessel thrombosis with glycoprotein IIb/IIIa inhibitor during GDC coil embolization. Stroke30: 693–695, 1999.
17.
HofmannLVRazaviMArepallyA: GP IIa-IIIb receptor inhibitors: What the interventional radiologist needs to know. Cardiovasc Intervent Radiol24: 361–367, 2001.
18.
MoussaIOetgenMRoubinG: Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation99: 2364–2366, 1999.
19.
MoussaIGishelNLawrenceE: Clopidogrel may enhance the clinical efficacy of carotid artery stent implantation: The EMILY registry. Presented in 25th International Stroke Conference: 2000 March 10–12: New Orleans. Stroke31: 299, 2000.
20.
WongSApplebergMWardCM: Aspirin resistance in cardiovascular disease: A review. Eur J Vasc Endovasc Surg27: 456–465, 2004.
21.
GurbelPABlidenKPHiattBLO'ConnorCM: Clopidogrel for coronary stenting: Response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation107: 2908–2913, 2003.
