Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
J Neurointerv Surg. 2020 Jan;12(1):67-71. doi: 10.1136/neurintsurg-2019-014944. Epub 2019 Sep 17.
Postprocedural thrombosis is a rare complication after flow diverting stent (FD) implantation for aneurysm treatment with few reported cases in the literature. Management strategies and outcomes associated with this complication have not been reported.
A multicenter retrospective series of cases of acute postprocedural FD thrombosis were compiled and prevalence was calculated based on procedural volumes over a 7 year period. Acute postprocedural FD thrombosis was defined as the development of neurologic deficit with angiographic imaging demonstrating acute thrombus within the index FD stent at least 2 hours following completion of the implantation procedure.
A total of 10 cases of postprocedural thrombosis were identified at five participating centers among a total of 768 patients treated (prevalence 1.3%). Thrombosis occurred a median of 5.5 days after implantation (range 0-83 days). 9/10 patients underwent emergent angiography with intent to perform endovascular reperfusion. A variety of different endovascular treatments were used, including aspiration thrombectomy, retrievable stent thrombectomy, balloon angioplasty, and intra-arterial thrombolytic infusion, without any procedural complications. There were no instances of FD migration, stent kinking, or aneurysm rupture. 90% of patients achieved Thrombolysis in Cerebral Infarction 2B or greater revascularization. Favorable clinical outcomes (modified Rankin Scale score of 0-2) at 3 months were achieved in 88% of patients.
Acute postprocedural thrombosis of an FD is a rare complication that occurs in approximately 1-2% of patients after aneurysm treatment. Patients presenting with acute postprocedural FD thrombosis should be aggressively managed using large vessel occlusion thrombectomy techniques, as good angiographic and clinical outcomes are possible.
血流导向支架（FD）植入治疗动脉瘤后发生的血栓形成是一种罕见的并发症，文献中报道的病例很少。尚未报道与该并发症相关的管理策略和结果。
我们汇编了多中心回顾性病例系列，报告了在 7 年期间内根据手术量计算出的急性术后 FD 血栓形成的患病率。急性术后 FD 血栓形成的定义为在植入手术后至少 2 小时的血管造影成像显示指数 FD 支架内急性血栓形成时发生神经功能缺损。
在 5 个参与中心共 768 例治疗患者中，共发现 10 例术后血栓形成（患病率 1.3%）。血栓形成发生在植入后中位数 5.5 天（范围 0-83 天）。9/10 例患者接受了紧急血管造影检查，意图进行血管内再灌注。使用了各种不同的血管内治疗方法，包括抽吸血栓切除术、可回收支架血栓切除术、球囊血管成形术和动脉内溶栓输注，没有任何手术并发症。没有 FD 迁移、支架扭结或动脉瘤破裂的情况。90%的患者达到了血栓切除术治疗脑梗死 2B 或更高的再通。88%的患者在 3 个月时达到了良好的临床结局（改良 Rankin 量表评分为 0-2）。
急性术后 FD 血栓形成是一种罕见的并发症，在治疗动脉瘤后约 1-2%的患者中发生。急性术后 FD 血栓形成的患者应积极采用大血管闭塞血栓切除术技术进行治疗，因为可以获得良好的血管造影和临床结果。
