In-stent thrombosis and stenosis after neck-remodeling device-assisted coil embolization of intracranial aneurysms.
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%.


CONCLUSIONS
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.
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15206, USA.
Hilal
H
Kanaan
Brian
B
Jankowitz
Aitziber
A
Aleu
Dean
D
Kostov
Ridwan
R
Lin
Kimberly
K
Lee
Narendra
N
Panipitiya
Yakov
Y
Gologorsky
Emir
E
Sandhu
Lauren
L
Rissman
Elizabeth
E
Crago
Yue-Fang
YF
Chang
Seong-Rim
SR
Kim
Tudor
T
Jovin
Michael
M
Horowitz
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002533:Cerebral Angiography / Q000379:methods; D003251:Constriction, Pathologic / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology*; D013997:Time Factors