Recanalization with subsequent near-total occlusion of an internal carotid artery aneurysm after immediate thrombotic occlusion using a flow-diverting stent

Case report

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A flow-diverting stent is placed in the parent artery to reduce blood flow in the aneurysm sac to facilitate progressive thrombosis and neointimal remodeling while maintaining outflow in the side branches and perforators. All international multicenter registries have reported on the progressive occlusion of aneurysms with time and have implied that an occluded aneurysm would not recanalize given the protective effect of the altered hemodynamics. Recanalization of an occluded aneurysm after placement of a flow-diverting stent has not been reported in the literature. The authors here describe a case of aneurysm recanalization after immediate thrombotic occlusion of the aneurysm with a flow-diverting stent. A 46-year-old male chronic smoker with chronic hypertension and hypercholesterolemia had a recurrent internal carotid artery aneurysm 1 year after embolization. Immediate thrombotic occlusion of the aneurysm and cessation of blood flow to the posterior communicating artery (PCoA) occurred immediately after activating a flow-diverting stent, with corresponding ischemic complications. However, 3 months after insertion of the stent, follow-up MR angiography showed recanalization of the aneurysm as well as of the PCoA. Additional angiography studies at 6 months showed near-total occlusion of the aneurysm with the restoration of blood flow to the PCoA.

Article Information

Address correspondence to: George Kwok Chu Wong, M.D., 4/F Clinical Science Building, Department of Neurosurgery, Prince of Wales Hospital, 1 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China. email: georgewong@surgery.cuhk.edu.hk.

Please include this information when citing this paper: published online January 6, 2012; DOI: 10.3171/2011.12.JNS111408.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Left ICA angiogram, lateral view, obtained at the 1-year follow-up, showing the recurrent aneurysm. B: Left ICA angiogram, lateral view, obtained immediately after PED activation, showing aneurysm occlusion together with fetal configuration PCoA occlusion. C: Left vertebral artery angiogram, anteroposterior view, showing the narrow first segment of the left PCA supplying the distal PCA with no retrograde filling of the PCoA. D: Postprocedural brain CT obtained on hospital Day 3, showing a small left occipital watershed infarct with hemorrhagic transformation (white arrow). E: Brain CT obtained at 1 month after stent treatment, showing a new infarct in the tail of the caudate nucleus and internal capsule extending to the corona radiata, compatible with an anterior choroidal artery territory infarct (white arrow).

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    A: Three-month follow-up MR angiogram showing reappearance of the aneurysm (black arrow) and the PCoA (1). Anterior choroidal artery is labeled 2. B: Six-month left ICA angiogram, lateral view, showing thrombotic occlusion of the aneurysm with recanalization of the PCoA (white arrow) and preservation of the anterior choroidal artery (black arrow). C: Rotational angiogram showing a tiny residual neck separated from the PCoA (white arrow).

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