Brainstem infarction after delayed thrombosis of a stented vertebral artery fusiform aneurysm: case report.
OBJECTIVE
Recent technological advances have provided clinicians with stents that can be navigated throughout the tortuous proximal vessels of the posterior intracranial circulation. There have been few reports of fusiform and wide-necked aneurysms treated with stents. Of the known risks involved in stent placement in the intracranial circulation, delayed stent thrombosis has not been well described.


METHODS
A 34-year-old man who experienced the sudden onset of a severe headache with increasing lethargy was found on computed tomographic imaging to have a subarachnoid hemorrhage. Angiography revealed a left vertebral artery fusiform aneurysm that incorporated the posteroinferior cerebellar artery origin.


METHODS
A low-porosity Magic Wallstent (Boston Scientific, Natick, MA) was placed in the left vertebral artery across the aneurysm and the origin of the posteroinferior cerebellar artery. Angiography performed 9 days later revealed significant reduction in filling of the aneurysm. The patient returned 3 months after stent placement with severe neurological deterioration from a brainstem infarction caused by complete thrombotic occlusion of the left vertebral artery at the stented segment of the vessel.


CONCLUSIONS
Stenting of fusiform aneurysms has provided an alternative to surgical clipping or parent vessel reconstruction. With the increasing frequency of intracranial stent placement for various cerebrovascular disease entities, we must become aware of potential complications associated with these procedures. Such awareness may influence decision-making processes regarding treatment and follow-up care.
Levy
Elad I
EI
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 3 Gates Circle, Buffalo, NY 14209-1194.
Boulos
Alan S
AS
Bendok
Bernard R
BR
Kim
Stanley H
SH
Qureshi
Adnan I
AI
Guterman
Lee R
LR
Hopkins
L Nelson
LN
D000328:Adult; D015901:Angiography, Digital Subtraction; D020526:Brain Stem Infarctions / Q000175:diagnosis / Q000209:etiology*; D002533:Cerebral Angiography; D017809:Fatal Outcome; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology*; D013997:Time Factors; D014711:Vertebral Artery