2017 Volume 2 Issue 1 Pages 11-17
Objective: We report a case of very late in-stent thrombosis occurred 15 months after an incomplete stent-assisted coil embolization.
Case Presentation: A 54-year-old woman presented with two unruptured aneurysms in the left internal carotid artery (ICA) and the left anterior cerebral artery (ACA). At first, a left ICA aneurysm was treated by balloon-assisted coil embolization with rescue stenting using the enterprise vascular reconstruction device (VRD) for the protruding coil into the left ICA. Postoperetive dual-energy CT demonstrated the wall apposition of Enterprise VRD. Dual antiplatelet therapy was continued for 6 months after coil embolization. Post 12 months, antiplatelet therapy was terminated. Subsequently, a clipping surgery was performed for a left ACA aneurysm 15 months after the coil embolization. Two hours after the surgery, she presented with right hemiparesis and aphasia. MRI-diffusion weighted image (MRI-DWI) showed early ischemic sign at the left hemisphere. CT angiography showed an in-stent thrombosis. Thrombolysis was performed immediately, however, postoperative MRI-DWI demonstrated infarction-related neurological deficits.
Conclusion: It is possible that the activation of platelet aggression, blood coagulation due to operative stress, and incomplete stent apposition of Enterprise VRD might cause very late in-stent thrombosis. This case may provide the considerable order of therapies, including endovascular treatment and clipping surgery, for cerebral aneurysms.
