Symptomatic Very Delayed Parent Artery Occlusion After Flow Diversion Stent Embolization

• Published in: Neurologia medico-chirurgica Vol. 56; no. 6; pp. 350 - 353
• Main Authors: ARAI, Hajime, NONAKA, Senshu, YAMAMOTO, Munetaka, TERANISHI, Kosuke, OISHI, Hidenori
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 01.01.2016; THE JAPAN NEUROSURGICAL SOCIETY
• Subjects: Aged; Aneurysm - therapy; antiplatelet therapy; Carotid Artery Diseases - therapy; Carotid Artery, Internal; Case Report; delayed parent artery occlusion; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - instrumentation; Female; flow diversion stent; Graft Occlusion, Vascular - diagnosis; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - therapy; Humans; intracranial aneurysm; Stents - adverse effects; Time Factors
• ISSN: 0470-8105; 1349-8029; 1349-8029
• DOI: 10.2176/nmc.cr.2016-0053

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.