Acute stent thrombosis after stent-assisted coiling in an intracranial aneurysm patient carrying two reduced-function CYP2C19 alleles: A case report. Issue 47 (November 2017)

• Record Type: Journal Article
• Authors: Ding, Lanping; Gu, Zhichun; Wang, Rong; Li, Yichen; Fang, Yun
• Other Names: NA. section editor.
• Is Part Of: Medicine. Volume 96:Issue 47(2017)
• Publication Date: 2017-11
• Subjects: acute stent thrombosis -- clopidogrel -- CYP2C19 gene polymorphism -- high on-treatment platelet reactivity -- intracranial aneurysm; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000008920
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Stent thrombosis (ST) remains a thorny issue in spite of dual antiplatelet treatment with aspirin plus clopidogrel after stent-assisted coiling (SAC). We report a first case of acute ST after SAC in an intracranial aneurysm (IA) patient who carries two reduced-function CYP2C19 alleles. Patient concerns: A 43-year-old Chinese male carrying two reduced-function CYP2C19 alleles was treated with a loading dose of clopidogrel 300 mg and aspirin 300 mg before SAC. Unfortunately, life-threatening ST appeared 0.5 h later after SAC. Interventions: A total of 100000U of urokinase was used to dissolve ST. Meanwhile, tirofiban and nodroparin was also administrated to prevent recurrent thrombotic events. Outcomes: A repeated angiography demonstrated a successful reperfusion after thrombolytic treatment. Lessons: The present case demonstrates that CYP2C19 allele carriers may lead to a suppressed antiplatelet effect of clopidogrel and a high risk of ST in the meantime. Therefore, CYP2C19 genetic testing seems to be able to identify patients-at-risk and optimal antiplatelet treatment should be considered in these fragile populations.