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

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

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.

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
  • 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
  • 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
  • 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
  • 5 Jiang X-L, Samant S, Lesko LJ, Schmidt S. Clinical pharmacokinetics and pharmacodynamics of clopidogrel. Clin Pharmacokinet 2015; 54 (02) 147-166
  • 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
  • 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
  • 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
  • 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