A Race Against Time: Contralateral Acute Limb Ischemia During Catheter‐Directed Thrombolysis for Peripheral In‐Stent Thrombosis—A Case Report
- 1Internal Medicine/Cardiology HCA Healthcare/USF Morsani College of Medicine GME/HCA Florida Largo Hospital Largo Florida USA
Abstract
Background: Acute limb ischemia (ALI) from peripheral in‐stent thrombosis is a vascular emergency requiring urgent revascularization. Catheter‐directed thrombolysis (CDT) is an established treatment option in selected patients, but development of contralateral ALI during active thrombolysis is rarely described.
Case Summary: A 70‐year‐old man with severe peripheral arterial disease, prior bilateral lower extremity stenting, coronary artery disease, diabetes mellitus, chronic kidney disease, and active tobacco use presented with acute left lower extremity pain, coolness, and absent pulses with preserved motor function most consistent with Rutherford Class IIa ALI. Imaging demonstrated extensive thrombosis involving previously placed left iliac and femoropopliteal stents. The patient underwent mechanical aspiration thrombectomy, balloon angioplasty, and left‐sided CDT. During ongoing thrombolytic therapy, he developed new right lower extremity discoloration and absent pulses with preserved motor and sensory function—also most consistent with Rutherford Class IIa ALI. Repeat angiography demonstrated restored left‐sided perfusion but new occlusion involving the right common femoral and superficial femoral arterial stents. Mechanical aspiration thrombectomy followed by right‐sided CDT restored bilateral limb perfusion.
Discussion: Contralateral ALI developing during CDT may have multifactorial causes, including underlying thrombotic susceptibility as well as local access or sheath‐related thrombosis. This case highlights the importance of bilateral vascular surveillance during thrombolytic therapy and prompt evaluation of new ischemic findings.
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BibTeX
@article{madishetty2026race,
title = {{A Race Against Time: Contralateral Acute Limb Ischemia During Catheter‐Directed Thrombolysis for Peripheral In‐Stent Thrombosis—A Case Report}},
author = {Vineet Madishetty and Abhinav Singh and Badal Sojitra and Alexander Yaylayan and Kevin Schneider and Merrill Krolick},
journal = {Case Reports in Cardiology},
year = {2026},
month = nov,
doi = {10.1155/cric/8253871},
url = {https://doi.org/10.1155/cric/8253871},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A Race Against Time: Contralateral Acute Limb Ischemia During Catheter‐Directed Thrombolysis for Peripheral In‐Stent Thrombosis—A Case Report
AU - Vineet Madishetty
AU - Abhinav Singh
AU - Badal Sojitra
AU - Alexander Yaylayan
AU - Kevin Schneider
AU - Merrill Krolick
PY - 2026
DA - 2026/11/04
JO - Case Reports in Cardiology
DO - 10.1155/cric/8253871
UR - https://doi.org/10.1155/cric/8253871
AB - Background: Acute limb ischemia (ALI) from peripheral in‐stent thrombosis is a vascular emergency requiring urgent revascularization. Catheter‐directed thrombolysis (CDT) is an established treatment option in selected patients, but development of contralateral ALI during active thrombolysis is rarely described. Case Summary: A 70‐year‐old man with severe peripheral arterial disease, prior bilateral lower extremity stenting, coronary artery disease, diabetes mellitus, chronic kidney disease, and active tobacco use presented with acute left lower extremity pain, coolness, and absent pulses with preserved motor function most consistent with Rutherford Class IIa ALI. Imaging demonstrated extensive thrombosis involving previously placed left iliac and femoropopliteal stents. The patient underwent mechanical aspiration thrombectomy, balloon angioplasty, and left‐sided CDT. During ongoing thrombolytic therapy, he developed new right lower extremity discoloration and absent pulses with preserved motor and sensory function—also most consistent with Rutherford Class IIa ALI. Repeat angiography demonstrated restored left‐sided perfusion but new occlusion involving the right common femoral and superficial femoral arterial stents. Mechanical aspiration thrombectomy followed by right‐sided CDT restored bilateral limb perfusion. Discussion: Contralateral ALI developing during CDT may have multifactorial causes, including underlying thrombotic susceptibility as well as local access or sheath‐related thrombosis. This case highlights the importance of bilateral vascular surveillance during thrombolytic therapy and prompt evaluation of new ischemic findings.
SN - 2090-6404
SN - 2090-6412
ER -