In-stent Thrombosis in the Middle Cerebral Artery (mca): A Case Report - In-stent Thrombosis in the Middle Cerebral Artery (mca): A Case Report - Open Access Pub

In-stent thrombosis (IST) is a complication of angioplasty and stenting, especially in the vessels with smaller diameter. We present a case of subacute IST after stenting treatment of an isolated higher stenosis of the right middle cerebral artery (MCA). Analysis of clinical features and emergent brain image helped to indicate the pathophysiological mechanism underlining the symptoms of this patient. Emergent Transcranial Doppler (TCD) helped to evaluate the compensatory collateral circulation and provided good supporting evidence in deducing the mechanism of IST. Slightly larger size of the implanted stent that caused dissection or vascular endothelium injury was presumed in this patient. Persistent evidence of inflammatory factors might also contribute to IST in this patient. DOI10.14302/issn.2470-5020.jnrt-14-520 In-stent thrombosis (IST) is a complication of angioplasty and stenting, especially in the vessels with smaller diameter. Postoperative vascular endothelium injury, collagen tissue exposure and the implanted stent may induce thrombosis.1 Infection and inflammation may also induce impairment of vascular endothelium, leading to thrombosis. When the thrombosis cannot be recognized and treated in time, restenosis of the artery may result. Here we report a case with IST in middle cerebral artery (MCA) and discuss the process of recognizing IST and the possible mechanisms of IST in this case. A twenty-nine-year-old female was admitted in Feb, 2006 because of episodic left limb numbness and weakness for half a year. The duration of the episode lasted for a few minutes, seldom over ten minutes. There was an attack every several days. She denied special medical history. She did not live in the pandemic area of Leptospirosis. Her blood pressure was 110/65mmHg and body weight was 51 kilograms. Physical examination found no abnormality. Magnetic resonance angiogram (MRA) (Feb 22) showed severe stenosis in the M1 segment of right MCA. In the source images of MRA, an oval area of abnormal signal in the right basal ganglion was found (Figure 1). Blood routines, coagulation tests, blood biochemistry tests, and C-reactive protein level were normal. The anti-nuclear antibody (ANA), anti-extractable nuclear antigen (ENA) antibodies, and anti-neutrophil cytoplasmic antibodies (ANCA) were negative. Serologic test for Syphilis was negative. Blood sedimentation rate (ESR) was 20 mm/h, and the level of anti-streptolysin O microtitration test (ASO) was 395 IU/ml (0-200 IU/ml). Digital subtraction angiography (DSA) detected severe stenosis (95%) in M1 segment of the