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Case Reports
. 2017 Nov 14:5:2050313X17741826.
doi: 10.1177/2050313X17741826. eCollection 2017.

Eversion endarterectomy under full prasugrel treatment

Thomas Kotsis  1 , Panagitsa Christoforou  1 , Nikolaos Asaloumidis  1 , Erifyli Argyra  2
Affiliations
Case Reports

Eversion endarterectomy under full prasugrel treatment

Thomas Kotsis et al. SAGE Open Med Case Rep. .

Abstract

The third-generation thienopyridine prasugrel has much stronger antiplatelet effect compared to other current antiplatelet inhibitors and exhibits practically zero resistance in healthy people. Prasugrel is used as a pre- and post-treatment in percutaneous coronary or neurovascular interventions with parallel aspirin regime. However, as there is a higher reported bleeding with intraluminal interventions and meticulous technique is recommended, there is nearly non-existent international experience of open surgery under full prasugrel treatment. We present, herein, a case of open carotid endarterectomy with the eversion technique in an asymptomatic patient with carotid stenosis, who was receiving dual antiplatelet therapy with aspirin and prasugrel, due to a previous insertion of two newer drug-eluting stents at the left anterior descending artery and the right coronary artery. The resistance test to prasugrel showed complete inhibition of platelet function. Open surgery was performed under continuation of prasugrel treatment and interruption of aspirin for 3 days before surgery. No perioperative and postoperative neurologic or cardiologic event occurred. No bleeding at the cervical or cerebral area was noted.

Keywords: Prasugrel; coronary stenting; eversion carotid endarterectomy.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The test of the patient’s resistance to prasugrel showed complete inhibition of platelet function.
Figure 2.
Figure 2.
The color Doppler ultrasound of carotids and vertebral arteries showed atherosclerotic plaque, which causes stenosis of right internal carotid artery up to 70% with peak systolic velocity up to 338 cm/s.
Figure 3.
Figure 3.
The digital subtraction head and neck angiography (DSA) of right common carotid artery showed kinking and marked stenosis of the right internal carotid artery.
Figure 4.
Figure 4.
Selective angiography of right common carotid artery.
Figure 5.
Figure 5.
Selective angiography of left common carotid artery showed greater blood flow than right common carotid artery.
Figure 6.
Figure 6.
Eversion endarterectomy under full prasugrel treatment, posterior wall anastomosis.
See this image and copyright information in PMC

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