Neurointervention.  2012 Feb;7(1):40-44. 10.5469/neuroint.2012.7.1.40.

Coincidental Occurrence of Acute In-stent Thrombosis and Iatrogenic Vessel Perforation During a Wingspan Stent Placement: Management with a Stent In-stent Technique

• Lee SJ
• Shin HS
• Lee SH
• Koh JS

• KMID: 1783998
• DOI: http://doi.org/10.5469/neuroint.2012.7.1.40

Abstract

We presented a case that an acute in-stent thrombosis after the deployment of a Wingspan stent was successfully managed with a stent in-stent technique. Because vessel perforation and subarachnoid hemorrhage were iatrogenically developed during the procedure, we were unable to use the thrombolytic agents to correct the in-stent thrombosis. When a thrombotic complication following an intracranial stent placement occurs with a coincidentally hemorrhagic complication, the stent in-stent technique should be considered as a treatment option.

Keyword

Wingspan stent; In-stent thrombosis; Stent in-stent technique

MeSH Terms

Fibrinolytic Agents
Glycosaminoglycans
Stents
Subarachnoid Hemorrhage
Thrombosis
Fibrinolytic Agents
Glycosaminoglycans

Figure

• 

  Fig. 1 A. Right internal carotid angiogram demonstrating a moderate stenosis of proximal M1 (arrowhead) and severe stenosis of distal M1 (arrow).B. Following angioplasty and stenting with 3.5×20 mm Wingspan system, a significant recanalization of stenotic segment with minimal residual stenosis is shown.C. Subtle extravasation of contrast media (arrowheads) at an angular portion of the lateral sulcus is shown on the lateral right carotid angiogram.D. Rotating flat panel CT revealing a small amount of extravasation of contrast media and subarachnoid hemorrhage at the right lateral sulcus and parietal sulci.E. 30-minute delayed angiogram demonstrating multifocal acute in-stent thrombosis, which compromises the flow to distal branches of right middle cerebral artery (MCA).F. Solitaire stent (4×20 mm) is deployed within the Wingspan stent to manage the acute in-stent thrombosis. Arrow denotes distal markers of Solitaire stent.G. 30-minute delayed angiogram after 2nd stent deployment, thrombosis within the Wingspan stent is resolved, and MCA is reopened.

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