Successful Recanalization Using the Direct Aspiration First Pass Technique for Acute Carotid Stent Thrombosis Following Carotid Artery Stenting

Acute carotid stent thrombosis is a known serious complication of carotid artery stenting (CAS) with no established standard treatment. Here, we present such a case wherein early recanalization with mechanical thrombectomy proved effective. An 80-year-old man underwent CAS for symptomatic left internal carotid artery stenosis. On postoperative day 4, he developed right hemiparesis and aphasia. Cranial imaging revealed a left cerebral infarction and left carotid stent thrombosis. Mechanical thrombectomy using the direct aspiration first pass technique was performed for the in-stent occlusion, resulting in successful recanalization. Due to a partial contrast filling defect within the stent after recanalization, 80 mg of ozagrel sodium was administered intravenously and prasugrel was delivered via a nasogastric tube. Subsequent angiography showed no re-occlusion or stenosis, and the procedure was completed. No recurrence of cerebral infarction was observed postoperatively, and the patient was transferred to a rehabilitation facility.