J Korean Neurosurg Soc.  2012 Jun;51(6):370-373. 10.3340/jkns.2012.51.6.370.

In-Stent Stenosis of Stent-Assisted Coil Embolization of the Supraclinoid Internal Carotid Artery Aneurysm

• Lee JI
• Ko JK
• Choi BK
• Choi CH

• KMID: 2190493
• DOI: http://doi.org/10.3340/jkns.2012.51.6.370

Abstract

The intracranial stent functions primarily to prevent protrusion of coils into the parent vessel during the embolization of wide-necked cerebral aneurysms and might also reduce aneurysm recanalization rate. In spite of these advantages, little is known about the long-term interaction of the stent with the parent vessel wall. We present a rare case of severe in-stent stenosis occurring as a delayed complication of Neuroform stent-assisted coil embolization of an unruptured intracranial aneurysm.

Keyword

Cerebral aneurysms; In-stent stenosis; Stent

MeSH Terms

Aneurysm
Carotid Artery, Internal
Constriction, Pathologic
Glycosaminoglycans
Humans
Intracranial Aneurysm
Parents
Stents
Glycosaminoglycans

Figure

• 

  Fig. 1 Left internal carotid artery angiogram depicting a broad-based aneurysm arising from the posterior wall of the left internal carotid artery.

• 

  Fig. 2 Unsubtracted image (A) depicting a Neuroform stent that was indicated by four radiopaque stent markers positioned across the neck of the coiled aneurysm with final one coil loop extrusion between stent cell and vessel wall. Subtracted image from a left internal carotid artery angiogram (B) demonstrating complete occlusion of the aneurysm. The stent is widely patent and the stented segment of the parent vessel appears completely intact. Specifically, there is no evidence of dissection or vasospasm.

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  Fig. 3 Left internal carotid artery angiogram obtained 9 months later demonstrating diffuse stenosis throughout the stented segment of the internal carotid artery, most severely within the mid-portion of the stent.

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  Fig. 4 After angioplasty of the stenotic segment, there is a marked improvement in the caliber of the lumen with improved flow throughout the internal carotid artery.

Reference

1. Cantón G, Levy DI, Lasheras JC, Nelson PK. Flow changes caused by the sequential placement of stents across the neck of sidewall cerebral aneurysms. J Neurosurg. 2005; 103:891–902. PMID: 16304994.

2. Collet JP, Montalescot G. Platelet function testing and implications for clinical practice. J Cardiovasc Pharmacol Ther. 2009; 14:157–169. PMID: 19721130.

3. Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG. In-stent stenosis as a delayed complication of neuroform stent-supported coil embolization of an incidental carotid terminus aneurysm. AJNR Am J Neuroradiol. 2004; 25:1764–1767. PMID: 15569743.

4. Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG. Usefulness of the Neuroform stent for the treatment of cerebral aneurysms : results at initial (3-6-mo) follow-up. Neurosurgery. 2005; 56:1191–1201. discussion 1201-1202. PMID: 15918935.

5. Fiorella D, Albuquerque FC, Han P, McDougall CG. Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery. 2004; 54:6–16. discussion 16-17. PMID: 14683536.

6. Fiorella D, Albuquerque FC, Woo H, Rasmussen PA, Masaryk TJ, McDougall CG. Neuroform in-stent stenosis: incidence, natural history, and treatment strategies. Neurosurgery. 2006; 59:34–42. discussion 34-42. PMID: 16823298.

7. Ismail Alhothi A, Qi T, Guo S, Shi Z, Liang F, Yang L, et al. Neuroform stent-assisted coil embolization : a new treatment strategy for complex intracranial aneurysms. Results of medium length follow-up. Neurol Neurochir Pol. 2010; 44:366–374. PMID: 20827610.

8. Kearney M, Pieczek A, Haley L, Losordo DW, Andres V, Schainfeld R, et al. Histopathology of in-stent restenosis in patients with peripheral artery disease. Circulation. 1997; 95:1998–2002. PMID: 9133506.

9. Kim M, Levy EI, Meng H, Hopkins LN. Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm. Neurosurgery. 2007; 61:1305–1312. discussion 1312-1313. PMID: 18162911.

10. Kipshidze N, Dangas G, Tsapenko M, Moses J, Leon MB, Kutryk M, et al. Role of the endothelium in modulating neointimal formation : vasculoprotective approaches to attenuate restenosis after percutaneous coronary interventions. J Am Coll Cardiol. 2004; 44:733–739. PMID: 15312851.

11. Lopes D, Sani S. Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent. Neurosurgery. 2005; 56:E416. discussion E416. PMID: 15670395.

12. Pride GL Jr, Horowitz MB, Purdy PD. Endovascular problem solving with intravascular stents. AJNR Am J Neuroradiol. 2000; 21:532–540. PMID: 10730647.

13. SSYLVIA Study investigators. Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA) : study results. Stroke. 2004; 35:1388–1392. PMID: 15105508.

14. Wanke I, Forsting M. Stents for intracranial wide-necked aneurysms : more than mechanical protection. Neuroradiology. 2008; 50:991–998. PMID: 18807024.

15. Yoon KW, Kim YJ. In-stent stenosis of stent assisted endovascular treatment on intracranial complex aneurysms. J Korean Neurosurg Soc. 2010; 48:485–489. PMID: 21430973.