Endovascular strategies for stroke management after subacute in-stent thrombosis

Saal‐Zapata, Giancarlo; Durand, Walter; Ghodke, Basavaraj; Walker, Melanie

doi:10.1016/j.jocn.2020.09.020

Cited by 4 publications

(4 citation statements)

References 2 publications

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“…Some reports have described how to perform the transcell technique safely, [4][5][6] but their complications are rarely reported. [7][8][9] In case of the Neuroform Atlas stent and Synchro SELECT entanglement, causing difficulty in removal, severe complications may occur.…”

Section: Discussionmentioning

confidence: 99%

A Case of Microguidewire and Neuroform Atlas Stent Entanglement Resulting in Extraction Difficulty

Yanagawa,

Shibata,

Tabata

et al. 2023

JNET

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Objective The trans-cell technique in stent-assisted coil embolization is a common treatment method for intracranial aneurysm. However, despite the frequency of its use, reports discussing its complications and their management are few. We describe a case of stent and microguidewire entanglement, which could not be removed, during treatment using the trans-cell technique. We discuss the mechanism of the entanglement and its management. Case Presentation A woman in her 40s was found to have an unruptured cerebral aneurysm with a maximum diameter of 5.9 mm located in the paraclinodal anterior process of the left internal carotid artery during a close examination of a headache. The aneurysm had an irregular shape and wide neck. Stent-assisted coil embolization was planned. Initially, the coil was embolized using a jailing technique, but the microcatheter was pushed out of the aneurysm during embolization. Thus, we attempted to switch to a trans-cell technique. However, during the process, the stent and microguidewire became entangled and could not be removed. Finally, when the stent slipped off, the entanglement was resolved and the microguidewire was retrieved. Fortunately, the patient was discharged home without postoperative complications. Conclusion Once a stent and a microguidewire become entangled, safely releasing them is difficult. Thus, it is important to avoid this scenario from occurring.

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Section: Discussionmentioning

confidence: 99%

A Case of Microguidewire and Neuroform Atlas Stent Entanglement Resulting in Extraction Difficulty

Yanagawa,

Shibata,

Tabata

et al. 2023

JNET

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show abstract

Section: Discussionmentioning

confidence: 99%

“…Some endovascular strategies for in-stent thrombosis have been reported. 17 Unfortunately in our institution, GPIIb/IIIa inhibitors are not available and when thrombosis occurs, intraarterial Alteplase administration and stent retrievers are used. We recommend stenting and a mean blood pressure above 90 mmHg in cases of coil protrusion in the setting of ICA agenesis in order to avoid potential thromboembolic complications.…”

Section: Discussionmentioning

confidence: 99%

Agenesis of the internal carotid artery associated with intracranial aneurysms: Endovascular treatment and intraoperative complications management

Saal‐Zapata

Rodríguez-Calienes

2022

Neuroradiol J

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Agenesis of the internal carotid artery (ICA) is a rare condition, whereas the association of this condition and the presence of intracranial aneurysms is higher in comparison to patients with normal vasculature. Endovascular treatment of this particular subgroup of patients has been described, but complications associated during treatment have not. Herein, we describe the endovascular treatment of intracranial aneurysms in two cases complicated with coil protrusion and in-stent thrombosis in the setting of agenesis of the ICA which were treated successfully without clinical compromise. One-year follow-up digital subtraction angiography demonstrated the complete obliteration of both aneurysms. In most of the cases, coil protrusion does not require further intervention; nevertheless, in the setting of ICA agenesis, stent placement is a potential alternative. In-stent thrombosis should be treated promptly with the available tools, in our case intra-arterial Alteplase reperfused the parent vessel.

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“…Stent thrombosis is a rare but serious complication that requires timely treatment. [3] A recent study reported a stent thrombosis rate of about 4% in patients receiving stent implantation. [4] Herein, we reported 2 cases with stent thrombosis in the vertebrobasilar artery, including their imaging and clinical findings, who were successfully treated with stent retriever thrombectomy.…”

Section: Introductionmentioning

confidence: 99%

Stent retriever thrombectomy in the treatment of basal artery stent thrombosis: Two case reports

Dai

Shu

et al. 2022

Medicine

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Rationale: Stent thrombosis is a rare but serious complication that requires timely treatment. Catheter thrombectomy is the first-line therapy for this condition; however, it may be challenging for patients with in-stent emboli located in the basilar artery.Patient concerns: Herein, we reported 2 cases with stent thrombosis in the vertebrobasilar artery, including their imaging and clinical findings. Both patients were successfully treated with stent retriever thrombectomy.Diagnosis: The presence of cerebral infarction was diagnosed by magnetic resonance. Cranial computed tomography excluded cerebral hemorrhage, and basilar artery occlusion was considered in combination with the medical history.Interventions: After cerebral angiography confirmed basilar artery occlusion, the stent thrombectomy was used to remove the thrombus.Outcomes: The emboli were removed from the stent, and the angiography confirmed that the blood flow in the posterior cerebral circulation was recovered to TICI level 3. Moreover, all symptoms disappeared.Lessons: Cerebral vascular stent thrombectomy is a feasible approach for treating cerebral vascular stent thrombosis.

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Endovascular strategies for stroke management after subacute in-stent thrombosis

Cited by 4 publications

References 2 publications

A Case of Microguidewire and Neuroform Atlas Stent Entanglement Resulting in Extraction Difficulty

A Case of Microguidewire and Neuroform Atlas Stent Entanglement Resulting in Extraction Difficulty

Agenesis of the internal carotid artery associated with intracranial aneurysms: Endovascular treatment and intraoperative complications management

Stent retriever thrombectomy in the treatment of basal artery stent thrombosis: Two case reports

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