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Case series
Endovascular management of acute postprocedural flow diverting stent thrombosis
  1. Robert Kyle Townsend1,
  2. Stacey Q Wolfe1,
  3. Mohammad Anadani2,
  4. Alejandro Spiotta2,
  5. Reade De Leacy3,
  6. J Mocco3,
  7. Rebecca M Garner1,
  8. Felipe C Albuquerque4,
  9. Andrew F Ducruet4,
  10. Peter Kan5,
  11. Kyle M Fargen1
  1. 1 Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
  2. 2 Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3 Neurosurgery, Mount Sinai Hospital, New York City, New York, USA
  4. 4 Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  5. 5 Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Kyle M Fargen, Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina 27109, USA; kfargen{at}wakehealth.edu

Abstract

Introduction Postprocedural thrombosis is a rare complication after flow diverting stent (FD) implantation for aneurysm treatment with few reported cases in the literature. Management strategies and outcomes associated with this complication have not been reported.

Methods A multicenter retrospective series of cases of acute postprocedural FD thrombosis were compiled and prevalence was calculated based on procedural volumes over a 7 year period. Acute postprocedural FD thrombosis was defined as the development of neurologic deficit with angiographic imaging demonstrating acute thrombus within the index FD stent at least 2 hours following completion of the implantation procedure.

Results A total of 10 cases of postprocedural thrombosis were identified at five participating centers among a total of 768 patients treated (prevalence 1.3%). Thrombosis occurred a median of 5.5 days after implantation (range 0–83 days). 9/10 patients underwent emergent angiography with intent to perform endovascular reperfusion. A variety of different endovascular treatments were used, including aspiration thrombectomy, retrievable stent thrombectomy, balloon angioplasty, and intra-arterial thrombolytic infusion, without any procedural complications. There were no instances of FD migration, stent kinking, or aneurysm rupture. 90% of patients achieved Thrombolysis in Cerebral Infarction 2B or greater revascularization. Favorable clinical outcomes (modified Rankin Scale score of 0–2) at 3 months were achieved in 88% of patients.

Conclusion Acute postprocedural thrombosis of an FD is a rare complication that occurs in approximately 1–2% of patients after aneurysm treatment. Patients presenting with acute postprocedural FD thrombosis should be aggressively managed using large vessel occlusion thrombectomy techniques, as good angiographic and clinical outcomes are possible.

  • aneurysm
  • flow diverter
  • stent
  • thrombectomy
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Footnotes

  • Contributors Concept design: KMF. Data collection: RKT, SQW, MA, AS, RD, JM, FCA, AD, PK, and KMF. Data review: RKT and KMF. Manuscript composition: RKT, RMG, and KMF. Final approval of the article: all authors.

  • 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.

  • Ethics approval Institutional review board approval was obtained at all participating centers.

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

  • Data sharing statement There are no additional data available.

  • Patient consent for publication Not required.

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