Subacute stent thrombosis in intracranial stenting.
OBJECTIVE
We sought to determine the safety of intracranial stenting with respect to subacute stent thrombosis in patients being treated with standardized antiplatelet therapy.


METHODS
We retrospectively evaluated the outcome of primary intracranial stenting of atherosclerotic stenoses and of stenting in coil embolization procedures in 67 patients. We focused on those cases that led to subacute stent thrombosis even though the patients had been treated with standardized antiplatelet therapy before, during, and after stent placement. Patient age ranged from 19 to 78 years. In 33 patients, stents were placed for treatment of atherosclerotic stenoses; in the remaining 34 patients, stents were placed to assist coiling of aneurysms. The patients in this study were treated between January 2003 and August 2007.


RESULTS
Of the total 67 patients initially treated successfully by intracranial stenting, 7 patients developed subacute stent thrombosis. Of these 7 patients, 3 received stent placement into the basilar artery because of an underlying stenosis; in 1 patient, a stenosis of the M1 segment of the middle cerebral artery was treated. In 3 patients, aneurysms of the anterior cerebral artery, the posterior inferior cerebellar artery, and the basilar artery were treated by stent-assisted coil embolization. In 4 of the 7 patients with subacute thrombosis, recanalization of stents by local application of recombinant tissue-type plasminogen activator was successful.


CONCLUSIONS
Intracranial stenting can lead to subacute stent thrombosis, even in patients who are treated with standardized antiplatelet therapy. Such complications have been described for patients after coronary artery stenting, but to our knowledge, no one has reported on a comparable number of cases of intracranial stenting procedures. In certain clinical scenarios, local thrombolysis with recombinant tissue-type plasminogen activator is an important treatment option to deal with subacute stent thrombosis.
Riedel
Christian H
CH
Department of Neuroradiology, UKS-H, Campus Kiel, Kiel, Germany. address c.riedel@neurorad.uni-kiel.de
Tietke
Marc
M
Alfke
Karsten
K
Stingele
Robert
R
Jansen
Olav
O
D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging; D001488:Basilar Artery / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator