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

摘要： 本文报道了一例老年女性院内卒中患者的临床诊疗过程。该患者于肛肠外科手术后2 d突发急性缺血性卒中，经影像学检查确诊为右侧颈内动脉起始部重度狭窄。在接受了1个月的卒中二级预防药物治疗后，择期行血管内治疗。术前该患者进行了快速细胞色素P450酶家族2亚家族C成员19（cytochrome P450 family 2 subfamily C member 19，CYP2C19）基因检测，结果为中间代谢型，提示应用氯吡格雷的效果可能不佳。基于这一检测结果调整抗血小板治疗方案，选择替格瑞洛联合阿司匹林作为替代治疗。治疗后，患者病情稳定，预后较好。本病例报道提示，在非轻型卒中患者中，快速CYP2C19基因检测可帮助选择抗血小板治疗策略，改善患者预后。

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