Document Detail

Subacute stent thrombosis in intracranial stenting.
MedLine Citation:
PMID:  19213948     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: We sought to determine the safety of intracranial stenting with respect to subacute stent thrombosis in patients being treated with standardized antiplatelet therapy. METHODS: We retrospectively evaluated the outcome of primary intracranial stenting of atherosclerotic stenoses and of stenting in coil embolization procedures in 67 patients. We focused on those cases that led to subacute stent thrombosis even though the patients had been treated with standardized antiplatelet therapy before, during, and after stent placement. Patient age ranged from 19 to 78 years. In 33 patients, stents were placed for treatment of atherosclerotic stenoses; in the remaining 34 patients, stents were placed to assist coiling of aneurysms. The patients in this study were treated between January 2003 and August 2007. RESULTS: Of the total 67 patients initially treated successfully by intracranial stenting, 7 patients developed subacute stent thrombosis. Of these 7 patients, 3 received stent placement into the basilar artery because of an underlying stenosis; in 1 patient, a stenosis of the M1 segment of the middle cerebral artery was treated. In 3 patients, aneurysms of the anterior cerebral artery, the posterior inferior cerebellar artery, and the basilar artery were treated by stent-assisted coil embolization. In 4 of the 7 patients with subacute thrombosis, recanalization of stents by local application of recombinant tissue-type plasminogen activator was successful. CONCLUSIONS: Intracranial stenting can lead to subacute stent thrombosis, even in patients who are treated with standardized antiplatelet therapy. Such complications have been described for patients after coronary artery stenting, but to our knowledge, no one has reported on a comparable number of cases of intracranial stenting procedures. In certain clinical scenarios, local thrombolysis with recombinant tissue-type plasminogen activator is an important treatment option to deal with subacute stent thrombosis.
Christian H Riedel; Marc Tietke; Karsten Alfke; Robert Stingele; Olav Jansen
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Publication Detail:
Type:  Journal Article     Date:  2009-02-12
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-04-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1310-4     Citation Subset:  IM    
Department of Neuroradiology, UKS-H, Campus Kiel, Kiel, Germany. address
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MeSH Terms
Anterior Cerebral Artery / radiography
Basilar Artery / radiography
Cerebral Angiography
Cerebral Infarction / etiology,  pathology
Fibrinolytic Agents / therapeutic use*
Intracranial Arteriosclerosis / therapy*
Intracranial Thrombosis / drug therapy*,  etiology*,  radiography
Magnetic Resonance Imaging
Middle Aged
Middle Cerebral Artery / radiography
Platelet Aggregation Inhibitors / therapeutic use
Retrospective Studies
Stents / adverse effects*
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; EC Plasminogen Activator

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