Neurointervention.  2011 Feb;6(1):38-41. 10.5469/neuroint.2011.6.1.38.

Total Occlusion of the Internal Carotid Artery by Subacute In-Stent Thrombosis and Subsequent Spontaneous Recanalization After Stent-Assisted Coil Embolization

• Lee CY
• Ryu CW
• Koh JS
• Kim EJ

• KMID: 1783982
• DOI: http://doi.org/10.5469/neuroint.2011.6.1.38

Abstract

We present a 61-year-old female with an unruptured intracranial aneurysm on the left superior hypophyseal artery. The patient was treated with endovascular management, stent-assisted coil embolization. Multiple embolic infarction and total occlusion of the left internal carotid artery (ICA) was occurred one day later. At 14 days of heparinization, complete recanalization of the ICA and full recovery of neurologic symptoms were achieved. Stent-assisted coil embolization is not without risk of instent thrombosis and the subsequent embolism. The cause of subacute in-stent thrombosis and natural course were uncertain; however, the clinical course may potentially be fatal. Therefore, rapid diagnosis and proper treatment are recommended.

Keyword

Subacute thrombosis; Recanalization; Stent-assisted coiling

MeSH Terms

Arteries
Carotid Artery, Internal
Embolism
Female
Heparin
Humans
Infarction
Intracranial Aneurysm
Middle Aged
Neurologic Manifestations
Thrombosis
Heparin

Figure

• 

  Fig. 1 A. A 61-year-old female, 3-dimensional rotation angiography demonstrates a left superior hypophyseal aneurysm.B. After insertion of 7 coils, two small loops protruded into the parent artery lumen. However, 3D-rotational angiography (not seen) demonstrated that coil loops were located between the parent artery and the stent.C. One day after the procedure, diffusion-weighted MR revealed focal multiple acute infarction due to a distal thromboembolism.D. MR angiography showed total occlusion of the distal ICA. However, cross filling was observed throughout the anterior communicating artery.E. At 2 weeks postoperatively, complete recanalization was confirmed in conventional angiography.

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