J Korean Neurosurg Soc.  2014 Oct;56(4):344-347. 10.3340/jkns.2014.56.4.344.

Very Late Stent Thrombosis after Sole Stent-Assisted Coiling at the Paraclinoid Giant Aneurysm : Could Prophylactic Antiplatelet Therapy Be Ceased at the Only 1 Year after Procedure?

• Shin JH
• Park SH
• Kim CH
• Lee CY

• KMID: 2018087
• DOI: http://doi.org/10.3340/jkns.2014.56.4.344

Abstract

Stent thrombosis is a major limitation of stent-assisted coiling, which is an effective method for treating wide-necked aneurysms. Although early in-stent thrombosis has been reported, very late stent thrombosis (VLST) (>1 year) has not been reported following implantation of a single self-expandable stent designed for coiling. Herein, the authors present a case of VLST that occurred 14 months after single stent implantation in a large paraclinoid aneurysm with an ultra-wide neck involving the parent artery circumferentially. This case indicates the need for establishing guidelines regarding the optimal duration of prophylactic antiplatelet therapy following stent-assisted coiling, which remains undefined in the neuroendovascular field.

Keyword

Aneurysm; Antiplatelet; Stent; Stent-assisted coiling; Very late stent thrombosis

MeSH Terms

Aneurysm*
Arteries
Humans
Neck
Parents
Stents*
Thrombosis*

Figure

• 

  Fig. 1 Three-dimensional angiography showing an aneurysm at the anterior communicating artery and a large aneurysm with a wide circumferential neck (arrow) at the paraclinoid internal carotid artery.

• 

  Fig. 2 A : Angiography taken immediately after coiling showing a minor amount of residual filling in the aneurysm neck and a preserved parent artery without any thrombosis. B : Same angle at 1-year follow-up angiography demonstrating no change in the small amount of residual filling of the aneurismal neck and no stenosis or thrombosis.

• 

  Fig. 3 A : Diffusion weighted image taken for evaluating the patient's ischemic symptoms demonstrating multiple embolic infarctions in the right hemisphere. B : Angiography obtained to evaluate the patient's ischemic symptoms showing in-stent thrombosis (arrows) extending from the cavernous internal carotid artery to the distal internal carotid artery. C : Follow-up angiography showing a completely resolved thrombosis after management with antiplatelet agents and systemic heparinization.

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