Endovascular Management of Symptomatic Carotid Artery Stenosis in a Patient with Thrombocytopenia

Abstract Background Various medical comorbidities such as thrombocytopenia can be obstacles for managing patients with carotid artery disease. Patient We describe our experience with urgent carotid artery stenting for symptomatic carotid artery stenosis in a patient with severe thrombocytopenia. During the treatment, several issues such as mechanism of infarction in carotid artery stenosis, timing of endovascular intervention, and decision making for intervention in patients with thrombocytopenia were discussed. Although the patient experienced complications after carotid artery stenting, he recovered with only mild sequelae. Results and Conclusion Timely decision is required and individualized treatment strategies should be considered to achieve good results under the given conditions.

[1]  P. Rothwell,et al.  Systematic Review of the Operative Risks of Carotid Endarterectomy for Recently Symptomatic Stenosis in Relation to the Timing of Surgery , 2009, Stroke.

[2]  F. Burzotta,et al.  Myocardial no-reflow in humans. , 2009, Journal of the American College of Cardiology.

[3]  G. Biondi-Zoccai,et al.  Idiopathic thrombocytopenic purpura and percutaneous coronary stenting: a dangerous duo? , 2008, International journal of cardiology.

[4]  Martin M. Brown Should carotid stenting replace carotid endarterectomy in routine clinical practice? , 2008, Practical Neurology.

[5]  C. Bajzer,et al.  Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting , 2007, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[6]  E. Peterson,et al.  ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on carotid stenting. , 2007, Vascular medicine.

[7]  J. Pimenta,et al.  Elective coronary stent implantation in a patient with unstable angina and thrombocytopenia. , 2005, The Journal of invasive cardiology.

[8]  Christian Weimar,et al.  Neurologic worsening during the acute phase of ischemic stroke. , 2005, Archives of neurology.

[9]  E. Ohman,et al.  Percutaneous coronary intervention in a patient with immune thrombocytopenia purpura , 2004, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[10]  J. Fareed,et al.  The First Report of Successful Carotid Stent Implant Using Argatroban Anticoagulation in a Patient with Heparin-Induced Thrombocytopenia and Thrombosis Syndrome , 1998, Angiology.

[11]  Lippincott Williams Wilkins,et al.  Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. , 1991, Stroke.