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A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization

OBJECTIVE: In-stent thrombosis (IST) is a known complication after stent-assisted coil (SAC) embolization. We report a case of mechanical thrombectomy using a stent retriever (SR) for IST and share our experience with this treatment to prevent a poor outcome in future cases. CASE PRESENTATION: The p...

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Autores principales: Furukawa, Yuya, Ichikawa, Tsuyoshi, Harigane, Yuki, Kikuta, Haruhiko, Nagai, Kenichiro, Suzuki, Kyouichi, Watanabe, Yoichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society for Neuroendovascular Therapy 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370789/
https://www.ncbi.nlm.nih.gov/pubmed/37501749
http://dx.doi.org/10.5797/jnet.cr.2020-0084
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author Furukawa, Yuya
Ichikawa, Tsuyoshi
Harigane, Yuki
Kikuta, Haruhiko
Nagai, Kenichiro
Suzuki, Kyouichi
Watanabe, Yoichi
author_facet Furukawa, Yuya
Ichikawa, Tsuyoshi
Harigane, Yuki
Kikuta, Haruhiko
Nagai, Kenichiro
Suzuki, Kyouichi
Watanabe, Yoichi
author_sort Furukawa, Yuya
collection PubMed
description OBJECTIVE: In-stent thrombosis (IST) is a known complication after stent-assisted coil (SAC) embolization. We report a case of mechanical thrombectomy using a stent retriever (SR) for IST and share our experience with this treatment to prevent a poor outcome in future cases. CASE PRESENTATION: The patient was a 62-year-old man. SAC embolization for an unruptured left internal carotid artery (ICA) aneurysm was performed. Three weeks after discharge, right hemiparesis and aphasia developed. Magnetic resonance imaging (MRI) demonstrated cerebral infarction in the left middle cerebral artery (MCA) territory and the left ICA was occluded. His relatives told us that the patient discontinued taking antiplatelet drugs. IST was diagnosed and emergency thrombectomy was performed. First, we tried to introduce an aspiration catheter or balloon catheter into the occluded lesion, but they were unable to be sufficiently inserted to the distal site. Therefore, we used a SR even though it carried a risk of friction on the deployed stent. The occluded artery was finally recanalized using the SR, but the stent became shortened. For the treatment strategy, sufficient medication (antithrombogenic agents and edaravone) should be administered first, followed by mechanical treatment. In mechanical treatment, thrombus fragmentation with a guidewire or balloon and aspiration should be attempted first. New aspiration catheters to carry the devices to the far distal site easily are now available. CONCLUSION: SRs cannot be utilized for thrombectomy with a stent. In emergency situations, careful consideration during troubleshooting rather than using a SR is needed.
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spelling pubmed-103707892023-07-27 A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization Furukawa, Yuya Ichikawa, Tsuyoshi Harigane, Yuki Kikuta, Haruhiko Nagai, Kenichiro Suzuki, Kyouichi Watanabe, Yoichi J Neuroendovasc Ther Case Report OBJECTIVE: In-stent thrombosis (IST) is a known complication after stent-assisted coil (SAC) embolization. We report a case of mechanical thrombectomy using a stent retriever (SR) for IST and share our experience with this treatment to prevent a poor outcome in future cases. CASE PRESENTATION: The patient was a 62-year-old man. SAC embolization for an unruptured left internal carotid artery (ICA) aneurysm was performed. Three weeks after discharge, right hemiparesis and aphasia developed. Magnetic resonance imaging (MRI) demonstrated cerebral infarction in the left middle cerebral artery (MCA) territory and the left ICA was occluded. His relatives told us that the patient discontinued taking antiplatelet drugs. IST was diagnosed and emergency thrombectomy was performed. First, we tried to introduce an aspiration catheter or balloon catheter into the occluded lesion, but they were unable to be sufficiently inserted to the distal site. Therefore, we used a SR even though it carried a risk of friction on the deployed stent. The occluded artery was finally recanalized using the SR, but the stent became shortened. For the treatment strategy, sufficient medication (antithrombogenic agents and edaravone) should be administered first, followed by mechanical treatment. In mechanical treatment, thrombus fragmentation with a guidewire or balloon and aspiration should be attempted first. New aspiration catheters to carry the devices to the far distal site easily are now available. CONCLUSION: SRs cannot be utilized for thrombectomy with a stent. In emergency situations, careful consideration during troubleshooting rather than using a SR is needed. The Japanese Society for Neuroendovascular Therapy 2021-01-11 2021 /pmc/articles/PMC10370789/ /pubmed/37501749 http://dx.doi.org/10.5797/jnet.cr.2020-0084 Text en ©2021 The Japanese Society for Neuroendovascular Therapy https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Case Report
Furukawa, Yuya
Ichikawa, Tsuyoshi
Harigane, Yuki
Kikuta, Haruhiko
Nagai, Kenichiro
Suzuki, Kyouichi
Watanabe, Yoichi
A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization
title A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization
title_full A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization
title_fullStr A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization
title_full_unstemmed A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization
title_short A Case of Percutaneous Thrombectomy for Internal Carotid Artery Occlusion due to In-Stent Thrombosis Following Stent-Assisted Intra-Aneurysmal Embolization
title_sort case of percutaneous thrombectomy for internal carotid artery occlusion due to in-stent thrombosis following stent-assisted intra-aneurysmal embolization
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370789/
https://www.ncbi.nlm.nih.gov/pubmed/37501749
http://dx.doi.org/10.5797/jnet.cr.2020-0084
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