关键词: 缺血性卒中; 颈内动脉; 细胞色素P450酶家族2亚家族C成员19基因; 氯吡格雷; 阿司匹林; 替格瑞洛

Abstract: This paper reported the clinical diagnosis and treatment process of an elderly female patient with in-hospital stroke. The patient suddenly developed acute ischemic stroke 2 days after an anorectal surgery and was diagnosed with severe stenosis at the origin of the right internal carotid artery by imaging examination. After one month of treatment with secondary prevention drugs for stroke, selective endovascular treatment was performed. The rapid detection of cytochrome P450 family 2 subfamily C member 19 (CYP2C19) gene before the operation showed that it was an intermediate metabolic type, suggesting that the effect of clopidogrel may be poor. Based on this result, the antiplatelet therapy regimen was adjusted and ticagrelor combined with aspirin was selected as a replacement therapy. After treatment, the patient’s condition was stable and the prognosis was good. This report suggests that rapid detection of the CYP2C19 gene can also be used to guide the selection of antiplatelet therapy strategies and improve outcomes in non-mild stroke patients.

Key words: Ischemic stroke; Internal carotid artery; Cytochrome P450 family 2 subfamily C member 19 gene; Clopidogrel; Aspirin; Ticagrelor