Importance of cerebral angiography in the evaluation of delayed carotid stent thrombosis: a case report

While noninvasive imaging is typically used during the initial assessment of carotid artery disease, digital subtraction angiography remains the gold standard for evaluating carotid stent thrombosis and stenosis (Krawisz in Cardiol Clin 39:539-549, 2021). This case highlights the importance of digit...

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Bibliographic Details
Published in:Journal of medical case reports 2024-02, Vol.18 (1), p.109-109, Article 109
Main Authors: Masoud, Zaki, Daza-Ovalle, Juan Felipe, Esenwa, Charles
Format: Article
Language:English
Subjects:
African Americans
Angiography
Apixaban
Atherosclerosis
Blood clot
Care and treatment
Carotid arteries
Carotid artery stenting
Case Report
Delayed carotid stent thrombosis
Diagnosis
Digital subtraction angiography
Dual antiplatelet therapy
Medical imaging
Morphology
Patient compliance
Spasticity
Stent (Surgery)
Stroke
Thrombosis
Tomography
Vein & artery diseases
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Summary:While noninvasive imaging is typically used during the initial assessment of carotid artery disease, digital subtraction angiography remains the gold standard for evaluating carotid stent thrombosis and stenosis (Krawisz in Cardiol Clin 39:539-549, 2021). This case highlights the importance of digital subtraction angiography for assessing carotid artery stent patency in place of non-invasive imaging. We present a 61-year-old African American male patient with a history of right cervical internal carotid artery dissection that was treated with carotid artery stenting and endovascular thrombectomy, who developed recurrent right hemispheric infarcts related to delayed carotid stent thrombosis. Digital subtraction angiography found multiple filling defects consistent with extensive in-stent thrombosis not clearly observed with magnetic resonance angiography. Etiology was likely secondary to chronic antiplatelet noncompliance. Therefore, the patient was treated medically with a heparin drip, and dual antiplatelet therapy (dAPT) was restarted. At 1-month follow-up the patient did not report new motor or sensory deficits. In the setting of delayed carotid stent thrombosis secondary to antiplatelet noncompliance, digital subtraction angiography may play an essential diagnostic role for early identification and determination of the most appropriate treatment.
ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-024-04379-5