頚動脈ステント内血栓症に対し緊急ステント留置術を追加した1例 [in Japanese] Stent-in-stent treatment for acute in-stent thrombosis after carotid artery stenting: a case report [in Japanese]
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<b>【目的】</b>頚動脈ステント留置術（CAS）後のステント内血栓症に対してstent-in-stent留置術を行い良好な結果が得られた1例を報告する．<b>【症例】</b>72歳男性．症候性左内頚動脈狭窄症に対しopen-cell stentを使用してCASを施行した．術後急性期に症候性進行性ステント内血栓症をきたしたため，closed-cell stentで追加CASを行い良好な結果を得た．<b>【結論】</b>CAS後のステント内血栓症に対して，血栓を壁側に抑え込むことのできるstent-in-stent留置術は，有効な治療となり得る．
<b>Objective</b>: Symptomatic in-stent thrombosis with or without plaque protrusion is a relatively rare but devastating complication of carotid artery stenting (CAS).<br><b>Case presentation</b>: A 72-year-old man presented with repeated transient ischemic attacks (TIAs). Digital subtraction angiography (DSA) showed severe stenosis in the left internal carotid artery at its origin. Cervical MRI revealed carotid soft plaque. Balloon-protected CAS was planned. A self-expandable open-cell-type stent (PRECISE<sup>TM</sup>) was successfully placed with a good angiographic result. However, he suffered a recurrent TIA several hours after the CAS procedure. Enhanced computed tomography (CT) scan revealed a contrast defect in the stent suggesting acute thrombus formation. Despite medical treatment including systemic heparinization and triple anti-platelet therapy, a follow-up ultra-sound examination showed enlargement of the thrombus in the stent. His neurological condition deteriorated and we decided to perform another stenting procedure. DSA demonstrated a significant contrast defect in the stent. A self-expandable closed-cell-type stent (Wallstent RP<sup>TM</sup>) was successfully deployed on the inside of a PRECISE<sup>TM</sup> stent under distal balloon protection. A satisfactory angiographic result was achieved. After the second procedure, he showed good recovery from the neurological symptoms and no more TIAs.<br><b>Conclusion</b>: This case demonstrated the usefulness of the stent-in-stent technique for medically refractory in-stent thrombosis with or without plaque protrusion. A closed-cell-type stent would be theoretically more effective in this situation.
- Journal of Neuroendovascular Therapy
Journal of Neuroendovascular Therapy 6(3), 181-188, 2012
The Japanese Society for Neuroendovascular Therapy