Neurological Sciences

, Volume 39, Issue 12, pp 2229–2230 | Cite as

In-stent thrombosis after carotid artery stenting in a patient with protein C deficiency

  • Yuichirou Iwamoto
  • Takaya KitanoEmail author
  • Shunji Matsubara
  • Masaaki Uno
  • Yoshiki Yagita
Letter to the Editor

Dear Editor:

In-stent thrombosis (IST) is a rare but serious complication of carotid artery stenting (CAS) [1]. However, the risk factors for IST have not been determined. We present a case of IST following CAS in a patient with protein C deficiency.

A 40-year-old otherwise healthy woman was admitted to our hospital because of weakness in her left upper limb. She had cerebral infarction in her early thirties, but no sequelae remained, and she was not on anti-thrombotic agents. She had started taking oral contraceptives 7 days prior to her presentation. On admission, the neurological examination revealed left hemiparesis, hemihypoesthesia, and unilateral spatial neglect. Magnetic resonance imaging revealed an acute cerebral infarction and occlusion in the horizontal segment of the right middle cerebral artery (Fig. 1a, b). Thus, an emergent mechanical thrombectomy was planned. A right carotid angiography that was performed prior to thrombectomy revealed a filling defect at the origin...


Compliance with ethical standards

Conflict of interest

One of the authors received an honorarium from Daiichi-Sankyo Co., Ltd., which is unrelated to the submitted work. All other authors have no conflicts of interest to declare.

Informed consent

An informed consent was obtained from the patient.


  1. 1.
    Ozaki S, Tagawa M, Matsumoto S, Inoue A, Watanabe H, Kumon Y, Oonishi T (2014) Pathogenesis of in-stent thrombosis after carotid artery stenting. No Shinkei Geka 42:1009–1017PubMedGoogle Scholar
  2. 2.
    Yoshida K, Nozaki K, Kikuta K, Sadato A, Miyamoto S, Hashimoto N (2003) Contrast-enhanced carotid color-coded duplex sonography for carotid stenting follow-up assessment. AJNR Am J Neuroradiol 24:992–995PubMedGoogle Scholar
  3. 3.
    Shimada H, Hisaeda E, Fukuda K, Higashi T, Ogata T, Kawashima H, Matsunaga A, Inoue T (2016) Usefulness of contrast enhanced ultrasonography for the evaluation of in-stent plaque protrusion after carotid artery stenting: a case report. Nosotchu 38:251–255CrossRefGoogle Scholar
  4. 4.
    Kanemaru K, Nishiyama Y, Yoshioka H, Satoh K, Hashimoto K, Hanihara M, Horikoshi T, Ozaki Y, Kinouchi H (2013) In-stent thrombosis after carotid artery stenting despite sufficient antiplatelet therapy in a bladder cancer patient. J Stroke Cerebrovasc Dis 22:1196–1200CrossRefPubMedGoogle Scholar
  5. 5.
    Goel PK, Batra A (2010) Protein C and/or protein S deficiency and occurrence of stent thrombosis: a hitherto unrecognized association. J Interv Cardiol 23:560–564CrossRefPubMedGoogle Scholar
  6. 6.
    Mahmoodi BK, Brouwer JL, Veeger NJ et al (2008) Hereditary deficiency of protein C or protein S confers increased risk of arterial thromboembolic events at a young age: results from a large family cohort study. Circulation 118:1659–1667CrossRefPubMedGoogle Scholar
  7. 7.
    Mahmoodi BK, Veeger NJ, Middeldorp S et al (2016) Interaction of hereditary thrombophilia and traditional cardiovascular risk factors on the risk of arterial thromboembolism: pooled analysis of four family cohort studies. Circ Cardiovasc Genet 9:79–85CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Stroke MedicineKawasaki Medical SchoolOkayamaJapan
  2. 2.Department of NeurologyOsaka University Graduate School of MedicineOsakaJapan
  3. 3.Department of NeurosurgeryKawasaki Medical SchoolOkayamaJapan

Personalised recommendations