Acute Carotid Stent Thrombosis in an Ultrarapid Clopidogrel Metabolizer: Case Report and Literature Review

Scientific paper - Review paper

• Author: Karlo Toljan
• Author: Ivan Jovanović
• Author: Katarina Starčević
• Author: Josip Ljevak
• Author: Nikola Blažević
• Author: Marko Radoš
• Author: Zdravka Poljaković
• Author's institution: University of Zagreb; School of Medicine; (Department of Neurology)
• Author's institution: University of Zagreb; School of Medicine; (Department of Radiology)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Radiology

Abstract (english)

Introduction: Carotid angioplasty and stenting (CAS) represents an effective procedure for treating carotid artery disease. The acute in-stent thrombosis is an extremely rare complication of CAS especially when it occurs postprocedurally during the first 24 hours. Improper antiplatelet therapy or poor response to antiplatelet medications is known to be associated with a higher risk of in-stent thrombosis during early postprocedural period following a successful intervention.
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Material and methods: A patient who experienced acute carotid in-stent thrombosis in early postprocedural period is described. He had been taking dual antiplatelet therapy for 2 weeks before undergoing a successful CAS. Moreover, pharmacogenetics studies showed the patient to be a clopidogrel ultrarapid metabolizer, which theoretically confers hyperresponsivity to medication. Alongside the report itself, a brief literature review of relevant sources pertinent to the case has been conducted.
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Results: According to the available literature, this is the first case report describing an ultrarapid clopidogrel metabolizer who underwent an uneventful CAS but experienced acute carotid in-stent thrombosis in early postprocedural period. A rescue procedure included an endovascular intervention consisting of thrombectomy and local alteplase application, followed by postprocedural administration of intravenous eptifibatide. At discharge, patient's dual antiplatelet therapy included ticagrelor instead of clopidogrel.
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Conclusion: Acute carotid in-stent thrombosis is a highly unexpected complication of CAS and can occur despite ultrarapid clopidogrel metabolism trait.

• Keywords (english): Acute Disease; Administration, Intravenous; Angiography, Digital Subtraction; Angioplasty, Balloon / adverse effects; Angioplasty, Balloon / instrumentation; Carotid Stenosis / diagnostic imaging; Carotid Stenosis / physiopathology; Carotid Stenosis / therapy; Clopidogrel / administration & dosage; Clopidogrel / metabolism; Computed Tomography Angiography; Cytochrome P-450 CYP2C19 / genetics; Cytochrome P-450 CYP2C19 / metabolism; Drug Substitution; Eptifibatide / administration & dosage; Genotype; Humans; Male; Middle Aged; Pharmacogenomic Variants; Phenotype; Platelet Aggregation Inhibitors / administration & dosage; Platelet Aggregation Inhibitors / metabolism; Risk Factors; Stents; Thrombectomy; Thrombosis / diagnostic imaging; Thrombosis / etiology; Thrombosis / therapy; Ticagrelor / administration & dosage; Treatment Outcome
• Language: english
• Publication type: Scientific paper - Review paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Accepted version
• Journal title: Vascular and Endovascular Surgery
• Numbering: vol. 53, no. 7, pp. 602-605
• p-ISSN: 1538-5744
• e-ISSN: 1938-9116
• DOI: https://doi.org/10.1177/1538574419857965
• URN:NBN: urn:nbn:hr:105:489880
• Publication: 2019-10
• Document URL: http://journals.sagepub.com/doi/10.1177/1538574419857965
• Type of resource: Text
• Access conditions: Open access
• Created on: 2021-02-08 12:28:49