Wednesday, November 15, 2017

Delayed ischemic stroke due to stent marker band occlusion after stent-assisted coiling

Be careful out there. I'm not planning on putting inflexible metal stents into my flexible arteries. But I'm not medically trained and should never be listened to.
http://www.docguide.com/delayed-ischemic-stroke-due-stent-marker-band-occlusion-after-stent-assisted-coiling

Kawabata S, Imamura H, Suzuki K, Tani S, Adachi H, Sakai N; BMJ Case Reports 2017 (Nov 2017)

A middle-aged patient with an internal carotid-posterior communicating artery aneurysm and basilar artery tip aneurysm was treated by stent-assisted coiling. One ischemic infarction and two transient ischemic attacks occurred with the same symptoms (inability to walk unassisted and tendency to fall to the left) during the first 2 years post-treatment. The ischemic infarction was found in the right side of the pons, consistent with the vascular territory of the stent-containing vessel. The cause of the delayed ischemic stroke was investigated on DSA and cone beam CT, which revealed that the proximal end of the stent, one marker band, was just covering a small perforating artery of the basilar artery trunk. The present case suggests that marker band occlusion can induce delayed ischemic stroke. To prevent this complication, it is important to evaluate the perforating vessels preoperatively and carefully deploy a stent for the marker band to avoid occlusion of large perforating vessels. Post-treatment evaluation is also important because dual antiplatelet therapy will be required for a longer period if an artery is occluded by a marker band.

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