An elderly case with late carotid stent thrombosis: possible role of antiphospholipid antibodies.

The case study speculates that the antiphospholipid antibodies acquired during the follow-up period of carotid artery stenting may cause late stent thrombosis that is resistant to direct oral anticoagulants. A 73-year-old man was hospitalized with complaints of weakness in the right lower extremity. The patient had undergone carotid artery stenting for symptomatic stenosis of the left internal carotid artery 6 years prior and had received antiplatelet therapy with clopidogrel 75 mg/day. As the patient had developed atrial fibrillation without stent stenosis at the age of 70 years, anticoagulation therapy with rivaroxaban15 mg/day was initiated while discontinuing clopidogrel. On admission, diffusion weighted imaging (DWI) revealed acute brain infarcts in the territory of the left middle cerebral artery. Contrast-enhanced computed tomography and cerebral angiography exposed severe stenosis in the left carotid artery accompanied by a filling defect caused by a floating thrombus. Laboratory examination revealed the presence of three types of antiphospholipid antibodies, with marked prolongation of activated partial thromboplastin time (APTT). Replacement of rivaroxaban with warfarin eliminated the thrombus without recurrent stroke. In conclusion, late stent thrombosis may be associated with antiphospholipid antibodies acquired during the follow-up period of carotid artery stenting.

[A case of pneumococcal meningitis with reversible arterial stenosis].

A 72-year-old male was diagnosed pneumococcal meningitis and we started treatment with antibacterial drugs and corticosteroids. On the 6th day, his consciousness level decreased. On the 7th day DWI of MRI showed a new infarction in bilateral cerebellar, and MRA showed multiple arterial stenosis. On the 12th day, CT angiography showed expansion of cerebral infarction and progress of diffuse stenosis. After that the stenosis improved over time, it disappeared on the 39th day. These results suggest that vasospasm is involved in the pathology of vascular stenosis.