In-stent thrombosis and stenosis after neck-remodeling device-assisted coil embolization of intracranial aneurysms

Neurosurgery. 2010 Dec;67(6):1523-32; discussion 1532-3. doi: 10.1227/NEU.0b013e3181f8d194.


Background: Intrinsic thrombosis and stenosis are complications associated with the use of neck-remodeling devices in the treatment of intracranial aneurysms.

Objective: To examine the technical and anatomic factors that predict short- and long-term stent patency.

Methods: We undertook a retrospective review of 161 patients who underwent coil embolization of 168 ruptured and unruptured aneurysms assisted by the use of a neck-remodeling device. One hundred twenty-seven patients had catheter-based angiographic follow-up to evaluate 133 stent-coil constructs (mean, 15.4 months; median, 12.7 months). The technique of microcatheter jailing was used in a majority of patients; nonstandard stent configurations were also used.

Results: Clinical follow-up for all patients who had catheter-based angiograms demonstrated that among 133 stent constructs, a total of 9 (6.8%) had an in-stent event: 6 acute or subacute thrombosis (4.5%) and 3 delayed stenosis or occlusion (2.3%). Seven of these constructs were associated with a symptomatic event (5.3%). A significantly higher rate of in-stent events was seen with the use of constructs to treat anterior communicating artery aneurysms. When all patients are considered, including those who did not receive catheter-based follow-up imaging, 2 of 168 procedures (1.2%) resulted in the death of a patient, and procedural morbidity was 14.9%.

Conclusion: From these results and those in the published literature, in-stent complication rates are low in carefully selected patients. The use of dual antiplatelet therapy, sensitivity assays, and glycoprotein IIb/IIIa inhibitors may decrease the rate of acute and chronic in-stent complications.

MeSH terms

  • Aged
  • Blood Vessel Prosthesis / adverse effects*
  • Cerebral Angiography / methods
  • Constriction, Pathologic / etiology
  • Embolization, Therapeutic / adverse effects*
  • Embolization, Therapeutic / instrumentation*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / therapy
  • Male
  • Middle Aged
  • Neck* / diagnostic imaging
  • Retrospective Studies
  • Thrombosis / etiology*
  • Time Factors