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.

该案例研究推测，颈动脉支架术后随访期间获得的抗磷脂抗体可能会导致对直接口服抗凝药耐药的晚期支架血栓形成。一名 73 岁男子因右下肢无力入院。该患者6年前曾因左颈内动脉症状性狭窄接受过颈动脉支架置入术，并接受过氯吡格雷75 mg/天的抗血小板治疗。由于患者70岁时出现房颤，无支架狭窄，因此开始利伐沙班15 mg/天抗凝治疗，同时停用氯吡格雷。入院时，弥散加权成像（DWI）显示左侧大脑中动脉区域存在急性脑梗死。对比增强计算机断层扫描和脑血管造影显示左颈动脉严重狭窄，并伴有漂浮血栓引起的充盈缺损。实验室检查发现存在三种类型的抗磷脂抗体，活化部分凝血活酶时间（APTT）显着延长。用华法林替代利伐沙班消除了血栓，没有复发中风。总之，晚期支架内血栓形成可能与颈动脉支架术后随访期间获得的抗磷脂抗体有关。