CardioVascular and Interventional Radiology

, Volume 38, Issue 4, pp 1011–1014 | Cite as

Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

  • Erkan KöklüEmail author
  • Şakir Arslan
  • İsa Öner Yüksel
  • Nermin Bayar
  • Pınar Koç
Case Report


Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication.


Antiplatelet resistance Carotid artery stenting Stent thrombosis Stroke 


Conflict of interest

Erkan Köklü, Şakir Arslan, İsa Öner Yüksel, Nermin Bayar, and Pınar Koç declare that they have no conflict of interest.


  1. 1.
    Brott TG, Hobson RW, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis (CREST). N Engl J Med 363:11–23PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Kanemaru K, Nishiyama Y, Yoshioka H et al (2013) In-stent thrombosis after carotid artery stenting despite sufficient antiplatelet therapy in a bladder cancer patient. J Stroke Cerebrovasc Dis 22:1196–1200PubMedCrossRefGoogle Scholar
  3. 3.
    Iancu A, Grosz C, Lazar A (2010) Acute carotid stent thrombosis: review of the literature and long-term follow-up. Cardiovasc Revasc Med 11:110–113PubMedCrossRefGoogle Scholar
  4. 4.
    Markus HS, Droste DW, Kaps M et al (2005) Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 111:2233–2240PubMedCrossRefGoogle Scholar
  5. 5.
    Steiner-Boker S, Cejna M, Nasel C et al (2004) Successful revascularization of carotid stent thrombosis by facilitated thrombolysis. AJNR Am J Neuroradiol 25:1411–1413PubMedGoogle Scholar
  6. 6.
    Gum PA, Kottke-Marchant K, Poggio ED et al (2001) Profile and prevalence of aspirin resistance in patients with cardiovascular disease. Am J Cardiol 88:230–235PubMedCrossRefGoogle Scholar
  7. 7.
    Dupont AG, Gabriel DA, Cohen MG (2009) Antiplatelet therapies and the role of antiplatelet resistance in acute coronary syndrome. Thromb Res 124:6–13PubMedCrossRefGoogle Scholar
  8. 8.
    Gurbel PA, Tantry US (2007) Clopidogrel resistance? Thromb Res 120:311–321PubMedCrossRefGoogle Scholar
  9. 9.
    Linnemann B, Schwonberg J, Rechner AR et al (2010) Assessment of clopidogrel non-response by the PFA-100 system using the new test cartridge Innovance PFA P2Y. Ann Hematol 89:597–605PubMedCrossRefGoogle Scholar
  10. 10.
    Wiper AJ, Roberts DH (2007) Stent thrombosis: consider also low response to antiplatelets. BMJ 334(7584):57PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Erkan Köklü
    • 1
    Email author
  • Şakir Arslan
    • 1
  • İsa Öner Yüksel
    • 1
  • Nermin Bayar
    • 1
  • Pınar Koç
    • 2
  1. 1.Clinic of CardiologyAntalya Education and Research HospitalAntalyaTurkey
  2. 2.Clinic of RadiologyAntalya Education and Research HospitalAntalyaTurkey

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