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Original research
Transient in-stent stenosis: a common finding after flow diverter implantation
  1. Ruben Mühl-Benninghaus,
  2. Alena Haußmann,
  3. Andreas Simgen,
  4. Toshiki Tomori,
  5. Wolfgang Reith,
  6. Umut Yilmaz
  1. Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
  1. Correspondence to Dr Ruben Mühl-Benninghaus, Department of Neuroradiology, Saarland University Hospital, Homburg 66421, Germany; ruben.mbe{at}gmail.com

Abstract

Background and purpose In recent years, implantation of flow diverters has emerged as an option for the endovascular treatment of intracranial aneurysms. One complication of treatment with flow diverters is the occurrence of in-stent stenosis, which has been reported to be partially reversible. The purpose of our study was to assess the incidence and dynamics of in-stent stenosis on angiographic short term and long term follow-up after treatment with flow diverters.

Methods A retrospective review of our prospectively maintained database identified all patients with intracranial internal carotid artery (ICA) aneurysms treated by flow diverters at our institution between 2014 and 2017. Clinical charts, procedural data, and angiographic results were reviewed.

Results 18 patients were included. The mean short term follow-up was 92±19 days and mean long term follow-up was 449±120 days after treatment. No neurologic complications were observed. There was no procedure related mortality. Long term angiographic results showed complete occlusion in 83.3%, neck remnants in 11.1%, and incomplete occlusion in 5.5% of cases. In-stent stenosis was observed in all cases. Mean stenosis improved significantly from 30% on short term follow-up to 12% on long-term follow-up (P<0.0001).

Conclusion In-stent stenosis is a common finding on short term follow-up after the treatment with flow diverters but improves over time.

  • flow diverter
  • stenosis
  • vessel wall
  • angiography
  • aneurysm

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Footnotes

  • Contributors RM-B: substantial contributions to the conception, design, analysis, and interpretation of data for the work; drafting the work and revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AH, AS, TT, WR, and UY: substantial contributions to the design of the work and analysis of data for the work; revising the work critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the ethics committee of Saarland, research protocol (266/17).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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