Symptomatic Very Delayed Parent Artery Occlusion After Flow Diversion Stent Embolization

Abstract

Flow diversion stents (FDSs) are constructed from high-density braided mesh, which alters intra-aneurysmal hemodynamics and leads to aneurysm occlusion by inducing thrombus formation. Although there are potential complications associated with FDS embolization, one of the serious complications is the parent artery occlusion due to the in-stent thrombosis. A 72-year-old woman with a symptomatic giant fusiform aneurysm in the cavernous segment of ICA underwent single-layer pipeline embolization device (PED) embolization. Six-month and 1-year follow-up conventional angiographies showed the residual blood flow in the aneurysm. Two-year follow-up MRI showed the aneurysm sac shrinkage and the antiplatelet therapy was discontinued. The patient suffered from symptomatic parent artery occlusion due to the in-stent thrombosis, 4 months after antiplatelet therapy discontinuation. The patient with the incompletely occluded aneurysm after PED embolization should be given long-term antiplatelet therapy because of the risk of delayed parent artery occlusion.

Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

“…If endothelialization in the oral anticoagulant group is impaired at the stent site, thrombotic complications may occur, so antiplatelet administration should be continued for longer than usual. 27 Hemorrhagic complications, that is delayed aneurysm rupture, were more common in the anticoagulant group. The WOEST study and DUAL-PCI study of coronary disease treatment found that concomitant use of oral anticoagulants in addition to DAPT promotes hemorrhagic complications.…”

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

“…This case was reported in the literature. 11) Another patient suffered a minor stroke immediately following the procedure. Diffusion weighted-imaging on the day of the procedure showed multiple high-intensity signals (HISs) in the treated cerebral hemisphere because of distal embolisms and/or parent artery flow insufficient during the PED deployment.…”

Exploring the Feasibility of Pipeline Embolization Device Compared With Stent-Assisted Coiling to Treat Non-saccular, Unruptured, Intradural Vertebral Artery Aneurysms

“…The authors concluded that noncompliance with antiplatelet medication and severe in-stent stenosis might lead to PAO and monitoring antiplatelet effectiveness might be useful to reduce the rate of this complication. Oishi et al reported the long-term follow-up of a patient with PAO who was treated with PED in their institution (20). The authors found thrombus development at the non-covered part with endothelium due to discontinuation of antiplatelet therapy and incomplete occlusion of the aneurysm; this was previously described by Kadirvel et al in an animal study of PED that investigated the cellular mechanisms of aneurysm occlusion (21).…”