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In-stent thrombosis and stenosis after neck-remodeling device-assisted coil embolization of intracranial aneurysms.
MedLine Citation:
PMID:  21107183     Owner:  NLM     Status:  In-Process    
BACKGROUND: Intrinsic thrombosis and stenosis are complications associated with the use of neck-remodeling devices in the treatment of intracranial aneurysms.
OBJECTIVE: To examine the technical and anatomic factors that predict short- and long-term stent patency.
METHODS: We undertook a retrospective review of 161 patients who underwent coil embolization of 168 ruptured and unruptured aneurysms assisted by the use of a neck-remodeling device. One hundred twenty-seven patients had catheter-based angiographic follow-up to evaluate 133 stent-coil constructs (mean, 15.4 months; median, 12.7 months). The technique of microcatheter jailing was used in a majority of patients; nonstandard stent configurations were also used.
RESULTS: Clinical follow-up for all patients who had catheter-based angiograms demonstrated that among 133 stent constructs, a total of 9 (6.8%) had an in-stent event: 6 acute or subacute thrombosis (4.5%) and 3 delayed stenosis or occlusion (2.3%). Seven of these constructs were associated with a symptomatic event (5.3%). A significantly higher rate of in-stent events was seen with the use of constructs to treat anterior communicating artery aneurysms. When all patients are considered, including those who did not receive catheter-based follow-up imaging, 2 of 168 procedures (1.2%) resulted in the death of a patient, and procedural morbidity was 14.9%.
CONCLUSION: From these results and those in the published literature, in-stent complication rates are low in carefully selected patients. The use of dual antiplatelet therapy, sensitivity assays, and glycoprotein IIb/IIIa inhibitors may decrease the rate of acute and chronic in-stent complications.
Hilal Kanaan; Brian Jankowitz; Aitziber Aleu; Dean Kostov; Ridwan Lin; Kimberly Lee; Narendra Panipitiya; Yakov Gologorsky; Emir Sandhu; Lauren Rissman; Elizabeth Crago; Yue-Fang Chang; Seong-Rim Kim; Tudor Jovin; Michael Horowitz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  67     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1523-32; discussion 1532-3     Citation Subset:  IM    
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15206, USA.
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