In-Stent Thrombosis and Stenosis After Neck-Remodeling Device-Assisted Coil Embolization of Intracranial Aneurysms

被引:49
作者
Kanaan, Hilal [1 ]
Jankowitz, Brian [1 ]
Aleu, Aitziber [1 ,5 ]
Kostov, Dean [1 ]
Lin, Ridwan [2 ]
Lee, Kimberly [1 ]
Panipitiya, Narendra [1 ]
Gologorsky, Yakov [4 ]
Sandhu, Emir [1 ]
Rissman, Lauren [1 ]
Crago, Elizabeth [1 ]
Chang, Yue-Fang [1 ]
Kim, Seong-Rim [1 ,3 ]
Jovin, Tudor [2 ]
Horowitz, Michael [1 ]
机构
[1] Univ Pittsburgh, Med Ctr, Dept Neurosurg, Pittsburgh, PA 15206 USA
[2] Univ Pittsburgh, Med Ctr, Dept Neurol, Pittsburgh, PA 15206 USA
[3] Catholic Univ Korea, Holy Family Hosp, Dept Neurosurg, Seoul, South Korea
[4] Mt Sinai Sch Med, Dept Neurosurg, New York, NY USA
[5] Univ Autonoma Barcelona, Dept Neurol, E-08193 Barcelona, Spain
关键词
Aneurysm; Coil; In-stent stenosis; Neck-remodeling device; Stent; Stent-assisted coiling; Stent-coil; STRATEGIES;
D O I
10.1227/NEU.0b013e3181f8d194
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:1523 / 1532
页数:10
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