Optical coherence tomography of the intracranial vasculature and Wingspan stent in a patient.
A 67-year-old man with medically refractory vertebrobasilar insufficiency and short segment occlusions of the intracranial vertebral arteries was treated with angioplasty and stent placement. Fifteen hours after the procedure the patient developed symptoms of posterior fossa ischemia and repeat angiography showed thrombus formation within the stent which was treated with thrombolytic and aggressive antiplatelet therapy. Angiography revealed lysis of the clot, but concerns regarding the mechanism of the thrombotic phenomenon prompted frequency-domain optical coherence tomography (FDOCT) assessment. FDOCT provided excellent visualization of the stent and vessel wall interactions, as well as excluding residual flow-limiting stenosis, obviating the need for further intervention. The potential utility of FDOCT in the evaluation of intracranial atherosclerotic disease and additional intracranial applications are discussed.
Neurosurgical Associates, Baptist Health Lexington, Lexington, Kentucky, USA.
Curtis Alden
CA
Given
Neurosurgical Associates, Baptist Health Lexington, Lexington, Kentucky, USA Department of Neurosurgery, Baptist Health Lexington, Lexington, Kentucky, USS.
Christian Norman
CN
Ramsey
Department of Cardiology, Case Western University, Cleveland, Ohio, USA.
Guilherme Ferragut
GF
Attizzani
Department of Cardiology, Baptist Health Lexington, Lexington, Kentucky, USA.
Michael R
MR
Jones
Neurosurgical Associates, Baptist Health Lexington, Lexington, Kentucky, USA Department of Neurosurgery, Baptist Health Lexington, Lexington, Kentucky, USS.
William H
WH
Brooks
Department of Cardiology, Case Western University, Cleveland, Ohio, USA.
Hiram G
HG
Bezerra
Department of Cardiology, Case Western University, Cleveland, Ohio, USA.
Marco A
MA
Costa
D000368:Aged; D017130:Angioplasty / Q000379:methods; D050197:Atherosclerosis / Q000473:pathology; D001921:Brain / Q000098:blood supply / Q000473:pathology*; D002533:Cerebral Angiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000473:pathology*; D015607:Stents; D013927:Thrombosis / Q000473:pathology* / Q000628:therapy; D041623:Tomography, Optical Coherence / Q000379:methods*; D014711:Vertebral Artery / Q000473:pathology* / Q000601:surgery; D014715:Vertebrobasilar Insufficiency / Q000601:surgery*
D005343:Fibrinolytic Agents
Atherosclerosis; Catheter; Stent; Technology; Vessel Wall