Transient Ischemic Attack Due to Early Carotid Stent Thrombosis: Successful Rescue with Rheolytic Thrombectomy and Systemic Abciximab

Abstract

Purpose: To describe a successful neurorescue technique in a patient with generalized seizures followed by hemiparesis immediately after carotid artery stenting (CAS) for a postsurgical restenosis. Case Report: A 65-year-old man with a symptomatic recurrent high-grade carotid stenosis after carotid endarterectomy was treated with CAS. The procedure was complicated by sudden transient ischemic attack caused by acute carotid stent thrombosis with clot propagation into the cerebral circulation. Percutaneous mechanical thrombectomy was performed with adjunctive infusion of intravenous abciximab, resulting in complete thrombus dissolution and resolution of neurological symptoms. Conclusions: Access to a mechanical thrombectomy device was essential for rapid thrombus extraction, and adjunctive abciximab aided in residual clot dissolution. As a result of this combined method of clot removal, a disastrous outcome was averted.