Risk Factors of Subacute Thrombosis After Intracranial Stenting for Symptomatic Intracranial Arterial Stenosis

Sun, Xuan; Tong, Xu; Lo, Wai Ting; Mo, Dapeng; Gao, Feng; Ma, Ning; Wang, Bo; Miao, Zhongrong

doi:10.1161/strokeaha.116.015538

Cited by 17 publications

(8 citation statements)

References 13 publications

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“…Recently, risk factors associated with stent thrombosis have been reported in some case series about intracranial stenting and stent-assisted coil embolization of intracranial aneurysms, including the stent design, different stenting procedures, poor stent adherence, smaller diameter of the stent, longer stent length, the location of stenosis, aspirin and/or clopidogrel resistance, and intimal injury from endovascular devices (9)(10)(11)(12). In our study, we found a high proportion of antiplatelet resistance in patients who developed AIST.…”

Section: Discussionsupporting

confidence: 59%

“…Currently, no definite guidelines exist regarding the optimal management of this complication during stent placement of ICAS. The present rescue treatments include intra-arterial thrombolysis with urokinase or tissue plasminogen activator (t-PA), intravenous bolus administration of potent GpIIb/IIIa inhibitors, balloon dilation, and restenting (2,3,10). The pathological evaluation of the aspirated thrombus material in clinical and autopsy series has demonstrated that the thrombus is almost totally composed of platelets and contains very low fibrin material (white clot) in the case of AIST, which may impact the efficacy of thrombolysis for this indication (13).…”

Section: Discussionmentioning

confidence: 99%

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Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis

et al. 2020

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Background and Purpose: The incidence of acute intraprocedural stent thrombosis (AIST) during stenting of intracranial atherosclerotic stenosis (ICAS) has seldom been reported and evidence regarding the treatment of AIST is lacking. We aim to investigate the incidence of AIST during stenting of ICAS in our institute, assess the preliminary efficacy and safety of rescue treatment of tirofiban for these patients. Methods: From September 2016 to May 2019, all symptomatic ICAS patients who underwent intracranial stenting in our institute were prospectively registered into this study, of which patients with AIST were retrospectively reviewed to extract baseline characteristics, perioperative management, procedural details, angiographic, and clinical outcomes. Rescue treatment of tirofiban for AIST was assessed by recanalization of the culprit vessel and periprocedural death, hemorrhage, and ischemic stroke. Results: Acute intraprocedural stent thrombosis developed in 12 (6.2%) patients within 30 min after stent placement of 194 patients. All 12 cases were successfully recanalized with modified Treatment in Cerebral Ischemia (mTICI) 3 and Arterial Occlusive Lesion (AOL) 3 after rescue treatment of tirofiban alone. There was no perioperative death or any hemorrhagic complication. Three patients suffered perioperative ischemic stroke. Conclusions: We observed a non-negligible rate of AIST during intracranial stenting procedures for ICAS. Intra-arterial bolus followed by intravenous tirofiban infusion seems to be efficacious and safe for AIST during stent placement for ICAS, without increasing the rate of hemorrhagic complications and death.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis

et al. 2020

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“…Thromboelastography was used to evaluate platelet reactivity. 20 No aspirin resistance was observed, and the 6 patients who showed clopidogrel resistance were treated with ticagrelor, 90 mg twice a day. Dual-antiplatelet therapy was maintained for 6 months, with life-long aspirin or clopidogrel monotherapy maintained thereafter.…”

Section: Endovascular Recanalization Proceduresmentioning

confidence: 99%

Endovascular Recanalization of Symptomatic Nonacute Intracranial Internal Carotid Artery Occlusion: Proposal of a New Angiographic Classification

Gao

Sun

Guo

et al. 2020

AJNR Am J Neuroradiol

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“…CYP2C19 genotypic analysis showed intermediate metabolizers. Previously, we showed that subacute stent thrombosis was significantly related with resistance to the treatment effects of aspirin or/and clopidogrel [17] . In this case, tirofiban was administered twice after stent implantation, but it failed to inhibit stent thrombosis., After the third stent implantation, according to the CYP2C19 genotypic analysis, we treated the patient with Ticagrelor instead of tirofiban, there was no recurrence of ISR.…”

Section: Discussionmentioning

confidence: 99%

Recurrent in-stent thrombosis following V4 segment of vertebral artery stenting: A case report

Zhang

Yan

Shen

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance We report a rare case of subacute recurrent in-stent thrombosis after vertebral artery stenting of the left intracranial segment. Case presentation A 56-year-old man presented with V4 segment severe stenosis of the left vertebral artery. Stent (Apollo, 2.5 mm × 8 mm) implantation was performed for severe stenosis of the left vertebral artery. Approximately 48 h after operation, the patient developed dizziness and drowsiness. DSA showed stent thrombosis, which was treated by PTAS (Apollo, 2.5 mm × 13 mm), and the preoperative symptoms resolved. Two days later, symptoms of posterior circulation ischemia reappeared, DSA showed recurrence of stent thrombosis and CYP2C19 genotypic analysis showed intermediate metabolizers. Revision PTAS (Enterprise, 4.5 mm × 28 mm) was performed followed by administration of Ticagrelor instead of tirofiban. The patient showed good neurological outcomes. CTA performed both one week and four months after the operation showed that the blood flow of the left vertebral artery was unobstructed. Clinical discussion Endovascular therapy is an alternative treatment for severe intracranial vascular stenosis, and reocclusion is one of the serious complications. Conclusion our case report highlights that recurrent in-stent thrombosis maybe be caused by inadequate preoperative assessment and unsuitable therapeutic drug selection for the stents.

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Risk Factors of Subacute Thrombosis After Intracranial Stenting for Symptomatic Intracranial Arterial Stenosis

Abstract: Tandem stenting and antiplatelet resistance might contribute to the development of SAT after intracranial stenting in patients with symptomatic intracranial arterial stenosis.

Cited by 17 publications

References 13 publications

Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis

Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis

Endovascular Recanalization of Symptomatic Nonacute Intracranial Internal Carotid Artery Occlusion: Proposal of a New Angiographic Classification

Recurrent in-stent thrombosis following V4 segment of vertebral artery stenting: A case report

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