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A CASE OF STENT THROMBOSIS
CLAUDIA SERRANO, MD CLINICAL ASSISTANT PROFESSOR NYU LANGONE
Disclosures:
▪ I have nothing to disclose.
A CASE OF STENT THROMBOSIS CLAUDIA SERRANO, MD CLINICAL ASSISTANT - - PowerPoint PPT Presentation
A CASE OF STENT THROMBOSIS CLAUDIA SERRANO, MD CLINICAL ASSISTANT - - PowerPoint PPT Presentation
A CASE OF STENT THROMBOSIS CLAUDIA SERRANO, MD CLINICAL ASSISTANT PROFESSOR NYU LANGONE Disclosures: I have nothing to disclose. 63 yo male Hypertension, and dyslipidemia Two recent long trips greater than 10 hours Presented
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- 63 yo male
- Hypertension, and dyslipidemia
- Two recent long trips greater than 10 hours
- Presented with 1 week of right lower extremity paresthesias and pain
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- Venous duplex ultrasound
- Patent veins
- Mass in the popliteal fossa
- MRI/MRA of the knee
- 4.5 cm popliteal aneurysm with occlusion of 8 cm segment of popliteal artery
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Peripheral angiography: Total occlusion of popliteal artery IVUS: 8.8 x 9.5 mm luminal diameter
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Revascularization: Pre-dilatation balloons: 4 x 150 mm 6 x 150 mm Covered stent: Viabahn 10 x 150 mm Post-dilatation balloons: 8 x 80 mm 9 x 40 mm 10 x 40 mm
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- Aspirin 81 mg daily
- Clopidogrel 75 mg daily
- Apixaban 5 mg BID
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3 weeks later Patient experience recurrence of rest leg pain on the right and rubor when standing Arterial ultrasound: Stent thrombosis
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Peripheral angiography: Left radial access Viabahn stent occluded Intervention: Local lytic therapy: Perfusion catheter tPA 20 mg bolus then 2 mg/h infusion x 6 hours, then 1.2 mg/h IV Anticoagulation: Heparin 500 U/h
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- Follow up peripheral angiography:
- Continue tPA to complete 24 hours infusion
- Ticagrelor 180 mg loading dose, then 90 mg BID
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- Aspirin held
- Clopidogrel held
- Apixaban held
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- Follow up angiography:
- tPA infusion completed x 48 hours
- IV heparin bridge to full anticoagulation with warfarin
- Continue with Ticagrelor 90 mg BID
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Patient returns 2 days later with acute onset right leg pain consistent with acute limb ischemia
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- Peroneal artery: Spider filter wire
- Popliteal and TP trunk: tPA infusion: 15 mg
- Popliteal: Thrombectomy with Jet Stream
- Popliteal and distal PT: Thrombectomy with 4 mm Angiojet
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- Peroneal and TP trunk: Dilatation balloon: 3 x 210 mm
- Distal PT: 4 mm Angiojet and 5 mg tPA infused followed by 4x 80 mm dilatation
- Popliteal: 1 mg/h tPA local infusion by perfusion catheter
- Heparin infusion 500 U/h
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Follow up angiography: Stop tPA Ticagrelor 90 mg BID Aspirin 81 mg daily Rivaroxaban 15 mg daily
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