[Revascularization with the Penumbra Aspiration System for symptomatic subacute in-stent occlusion after carotid artery stenting: a case report]

Carotid in-stent thrombosis can cause thromboembolic events although it is a rare complication of carotid artery stenting(CAS). We present a successful case of percutaneous mechanical thrombectomy for symptomatic subacute in-stent thrombosis. A 64-year-old man was hospitalized for the treatment of a cerebral infarction presenting with dysarthria and left upper extremity weakness. Following sufficient medical management including dual anti-platelet therapy, CAS was performed because cerebral angiograms showed severe and long-segment right internal carotid artery(ICA)stenosis. Although the stenosis was resolved, right cerebral infarction presented with progressive left hemiparesis 12 days after CAS. Emergency cerebral angiograms revealed right ICA occlusion due to in-stent thrombosis. Rapid revascularization with percutaneous mechanical thrombectomy of the in-stent occlusion was performed using the Penumbra Aspiration System because a microguidewire could not pass through the occlusion. Post-procedural angiogram revealed recanalization of the right ICA, and the patient was free from neurological events after the last procedure. The evaluation and treatment of peri-procedural in-stent thrombosis following CAS must be prompt and aggressive for prevention of catastrophic events. Percutaneous mechanical thrombectomy is a useful tool for rapid treatment of acute or subacute in-stent thrombosis after CAS.