Download PDF
J Neurol Surg A Cent Eur Neurosurg 2024; 85(05): 531-533
DOI: 10.1055/a-1877-0421
Case Report

Hyperacute in-Stent Thrombosis Causing Large Vessel Occlusion after Stent-Assisted Aneurysm Coiling Secondary to Complete Clopidogrel and Prasugrel Resistance: a Case Report

Elissa Xian 
1   Royal Prince Alfred Hospital, Camperdown, NSW, Sydney, Australia
,
Thomas Morrison
1   Royal Prince Alfred Hospital, Camperdown, NSW, Sydney, Australia
,
Johnny Wong
1   Royal Prince Alfred Hospital, Camperdown, NSW, Sydney, Australia
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Dual antiplatelet therapy (DAPT) is standard treatment for endoluminal stent insertion, and complete resistance to DAPT is rare. A case of in-stent thrombosis occurring 3 hours after stent-assisted coiling of internal carotid artery aneurysm is presented despite compliance with DAPT. Platelet function tests (PFTs) revealed complete clopidogrel and prasugrel resistance.

Keywords

antiplatelet therapy - large vessel occlusion - prasugrel resistance - clopidogrel resistance - platelet function testing - aneurysm stent

Author Contribution

All authors contributed significantly to the writing and editing of the manuscript.




Publication History

Received: 06 February 2022

Accepted: 13 June 2022

Accepted Manuscript online:
15 June 2022

Article published online:
05 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Riedel CH, Tietke M, Alfke K, Stingele R, Jansen O. Subacute stent thrombosis in intracranial stenting. Stroke 2009; 40 (04) 1310-1314
    CrossrefPubMedSearch in Google Scholar
  • 2 Nii K, Inoue R, Morinaga Y, Mitsutake T, Hanada H. Evaluation of acute in-stent thrombosis during stent-assisted coil embolization of unruptured intracranial aneurysms. Neurol Med Chir (Tokyo) 2018; 58 (10) 435-441
    CrossrefPubMedSearch in Google Scholar
  • 3 Larco JA, Abbasi M, Liu Y. et al. Postprocedural thrombosis following endovascular treatment of intracranial aneurysm with flow diverters or coiling: a histologic study. AJNR Am J Neuroradiol 2022; 43 (02) 258-264
    CrossrefPubMedSearch in Google Scholar
  • 4 Warlo EMK, Arnesen H, Seljeflot I. A brief review on resistance to P2Y12 receptor antagonism in coronary artery disease. Thromb J 2019; 17: 11
    CrossrefPubMedSearch in Google Scholar
  • 5 Jiang X-L, Samant S, Lesko LJ, Schmidt S. Clinical pharmacokinetics and pharmacodynamics of clopidogrel. Clin Pharmacokinet 2015; 54 (02) 147-166
    CrossrefPubMedSearch in Google Scholar
  • 6 Rho G-J, Shin W-R, Kong T-S, Kim M-S, Lee C-J, Lee B-H. Significance of clopidogrel resistance related to the stent-assisted angioplasty in patients with atherosclerotic cerebrovascular disease. J Korean Neurosurg Soc 2011; 50 (01) 40-44
    CrossrefPubMedSearch in Google Scholar
  • 7 Sedat J, Chau Y, Gaudart J, Sachet M, Beuil S, Lonjon M. Prasugrel versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms. Interv Neuroradiol 2017; 23 (01) 52-59
    CrossrefPubMedSearch in Google Scholar
  • 8 Steg PG, Harrington RA, Emanuelsson H. et al; PLATO Study Group. Stent thrombosis with ticagrelor versus clopidogrel in patients with acute coronary syndromes: an analysis from the prospective, randomized PLATO trial. Circulation 2013; 128 (10) 1055-1065
    CrossrefPubMedSearch in Google Scholar
  • 9 Taylor LI, Dickerson JC, Dambrino RJ. et al. Platelet testing in flow diversion: a review of the evidence. Neurosurg Focus 2017; 42 (06) E5
    CrossrefPubMedSearch in Google Scholar