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Coincidental Occurrence of Acute In-stent Thrombosis and Iatrogenic Vessel Perforation During a Wingspan Stent Placement: Management with a Stent In-stent Technique.

Lee SJ, Shin HS, Lee SH, Koh JS - Neurointervention (2012)

Bottom Line: We presented a case that an acute in-stent thrombosis after the deployment of a Wingspan stent was successfully managed with a stent in-stent technique.Because vessel perforation and subarachnoid hemorrhage were iatrogenically developed during the procedure, we were unable to use the thrombolytic agents to correct the in-stent thrombosis.When a thrombotic complication following an intracranial stent placement occurs with a coincidentally hemorrhagic complication, the stent in-stent technique should be considered as a treatment option.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea.

ABSTRACT
We presented a case that an acute in-stent thrombosis after the deployment of a Wingspan stent was successfully managed with a stent in-stent technique. Because vessel perforation and subarachnoid hemorrhage were iatrogenically developed during the procedure, we were unable to use the thrombolytic agents to correct the in-stent thrombosis. When a thrombotic complication following an intracranial stent placement occurs with a coincidentally hemorrhagic complication, the stent in-stent technique should be considered as a treatment option.

No MeSH data available.


Related in: MedlinePlus

A. Right internal carotid angiogram demonstrating a moderate stenosis of proximal M1 (arrowhead) and severe stenosis of distal M1 (arrow).B. Following angioplasty and stenting with 3.5×20 mm Wingspan system, a significant recanalization of stenotic segment with minimal residual stenosis is shown.C. Subtle extravasation of contrast media (arrowheads) at an angular portion of the lateral sulcus is shown on the lateral right carotid angiogram.D. Rotating flat panel CT revealing a small amount of extravasation of contrast media and subarachnoid hemorrhage at the right lateral sulcus and parietal sulci.E. 30-minute delayed angiogram demonstrating multifocal acute in-stent thrombosis, which compromises the flow to distal branches of right middle cerebral artery (MCA).F. Solitaire stent (4×20 mm) is deployed within the Wingspan stent to manage the acute in-stent thrombosis. Arrow denotes distal markers of Solitaire stent.G. 30-minute delayed angiogram after 2nd stent deployment, thrombosis within the Wingspan stent is resolved, and MCA is reopened.
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Figure 1: A. Right internal carotid angiogram demonstrating a moderate stenosis of proximal M1 (arrowhead) and severe stenosis of distal M1 (arrow).B. Following angioplasty and stenting with 3.5×20 mm Wingspan system, a significant recanalization of stenotic segment with minimal residual stenosis is shown.C. Subtle extravasation of contrast media (arrowheads) at an angular portion of the lateral sulcus is shown on the lateral right carotid angiogram.D. Rotating flat panel CT revealing a small amount of extravasation of contrast media and subarachnoid hemorrhage at the right lateral sulcus and parietal sulci.E. 30-minute delayed angiogram demonstrating multifocal acute in-stent thrombosis, which compromises the flow to distal branches of right middle cerebral artery (MCA).F. Solitaire stent (4×20 mm) is deployed within the Wingspan stent to manage the acute in-stent thrombosis. Arrow denotes distal markers of Solitaire stent.G. 30-minute delayed angiogram after 2nd stent deployment, thrombosis within the Wingspan stent is resolved, and MCA is reopened.

Mentions: A 66-year-old female was presented to the emergency room with sudden weakness on her left side and dysarthria while taking aspirin. She had already suffered a transient ischemic attack 3 days ago. Diffusion weighted magnetic resonance imaging (MRI) showed several small acute infarctions scattered in her right frontal cortex and basal ganglia. MR angiography revealed a severe stenosis of the right middle cerebral artery (MCA). Digital subtraction angiography (DSA) confirmed the severe long segment stenosis of the MCA and a significant decrease of flow velocity to the distal segment (Fig. 1A). We suspected that her current medical treatment would be ineffective to prevent another stroke, and thus, we planned an endovascular treatment. An endovascular procedure was performed 1 week later when her left-sided weakness was almost recovered. She received a daily oral administration of 325 mg of aspirin and 75 mg of clopidogrel before the procedure.


Coincidental Occurrence of Acute In-stent Thrombosis and Iatrogenic Vessel Perforation During a Wingspan Stent Placement: Management with a Stent In-stent Technique.

Lee SJ, Shin HS, Lee SH, Koh JS - Neurointervention (2012)

A. Right internal carotid angiogram demonstrating a moderate stenosis of proximal M1 (arrowhead) and severe stenosis of distal M1 (arrow).B. Following angioplasty and stenting with 3.5×20 mm Wingspan system, a significant recanalization of stenotic segment with minimal residual stenosis is shown.C. Subtle extravasation of contrast media (arrowheads) at an angular portion of the lateral sulcus is shown on the lateral right carotid angiogram.D. Rotating flat panel CT revealing a small amount of extravasation of contrast media and subarachnoid hemorrhage at the right lateral sulcus and parietal sulci.E. 30-minute delayed angiogram demonstrating multifocal acute in-stent thrombosis, which compromises the flow to distal branches of right middle cerebral artery (MCA).F. Solitaire stent (4×20 mm) is deployed within the Wingspan stent to manage the acute in-stent thrombosis. Arrow denotes distal markers of Solitaire stent.G. 30-minute delayed angiogram after 2nd stent deployment, thrombosis within the Wingspan stent is resolved, and MCA is reopened.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3299949&req=5

Figure 1: A. Right internal carotid angiogram demonstrating a moderate stenosis of proximal M1 (arrowhead) and severe stenosis of distal M1 (arrow).B. Following angioplasty and stenting with 3.5×20 mm Wingspan system, a significant recanalization of stenotic segment with minimal residual stenosis is shown.C. Subtle extravasation of contrast media (arrowheads) at an angular portion of the lateral sulcus is shown on the lateral right carotid angiogram.D. Rotating flat panel CT revealing a small amount of extravasation of contrast media and subarachnoid hemorrhage at the right lateral sulcus and parietal sulci.E. 30-minute delayed angiogram demonstrating multifocal acute in-stent thrombosis, which compromises the flow to distal branches of right middle cerebral artery (MCA).F. Solitaire stent (4×20 mm) is deployed within the Wingspan stent to manage the acute in-stent thrombosis. Arrow denotes distal markers of Solitaire stent.G. 30-minute delayed angiogram after 2nd stent deployment, thrombosis within the Wingspan stent is resolved, and MCA is reopened.
Mentions: A 66-year-old female was presented to the emergency room with sudden weakness on her left side and dysarthria while taking aspirin. She had already suffered a transient ischemic attack 3 days ago. Diffusion weighted magnetic resonance imaging (MRI) showed several small acute infarctions scattered in her right frontal cortex and basal ganglia. MR angiography revealed a severe stenosis of the right middle cerebral artery (MCA). Digital subtraction angiography (DSA) confirmed the severe long segment stenosis of the MCA and a significant decrease of flow velocity to the distal segment (Fig. 1A). We suspected that her current medical treatment would be ineffective to prevent another stroke, and thus, we planned an endovascular treatment. An endovascular procedure was performed 1 week later when her left-sided weakness was almost recovered. She received a daily oral administration of 325 mg of aspirin and 75 mg of clopidogrel before the procedure.

Bottom Line: We presented a case that an acute in-stent thrombosis after the deployment of a Wingspan stent was successfully managed with a stent in-stent technique.Because vessel perforation and subarachnoid hemorrhage were iatrogenically developed during the procedure, we were unable to use the thrombolytic agents to correct the in-stent thrombosis.When a thrombotic complication following an intracranial stent placement occurs with a coincidentally hemorrhagic complication, the stent in-stent technique should be considered as a treatment option.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea.

ABSTRACT
We presented a case that an acute in-stent thrombosis after the deployment of a Wingspan stent was successfully managed with a stent in-stent technique. Because vessel perforation and subarachnoid hemorrhage were iatrogenically developed during the procedure, we were unable to use the thrombolytic agents to correct the in-stent thrombosis. When a thrombotic complication following an intracranial stent placement occurs with a coincidentally hemorrhagic complication, the stent in-stent technique should be considered as a treatment option.

No MeSH data available.


Related in: MedlinePlus