Carotid Artery Stenting for Acute Ischemic Stroke Patients after Intravenous Recombinant Tissue Plasminogen Activator...

Area of Science:

• Neurology
• Interventional Cardiology
• Vascular Surgery

Background:

• Ischemic stroke treatment often involves reperfusion therapies like intravenous tissue plasminogen activator (t-PA).
• Carotid artery stenting is an emergency procedure for select ischemic stroke patients.
• Optimal antiplatelet strategies during and after stenting in t-PA treated patients remain under investigation.

Observation:

• Three patients with acute ischemic stroke underwent emergency carotid artery stenting post-t-PA administration.
• Patients received immediate antiplatelet loading and dual antiplatelet therapy (DAPT) post-procedure.
• No symptomatic intracranial hemorrhaging was observed in any patient during the follow-up period.

Findings:

• Despite high-dose and dual antiplatelet therapy, one patient developed acute stent thrombosis and reocclusion.
• The remaining two patients had successful stent patency without hemorrhagic complications.
• This case highlights a potential risk of thrombotic complications even with aggressive antiplatelet regimens.

Implications:

• Current antiplatelet protocols may require modification for patients undergoing emergency carotid stenting after t-PA.
• Further research is needed to establish optimal dual antiplatelet therapy strategies to prevent stent thrombosis in this specific patient population.
• Developing tailored treatment algorithms is crucial for improving outcomes in acute ischemic stroke patients treated with combined reperfusion and endovascular therapy.