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- W4386032359 abstract "<h3>Introduction</h3> Flow diversion stents are effective for treating fusiform and wide-neck aneurysms, but postprocedural complications remain concerning, including parent vessel occlusion, in-stent thrombosis and in-stent stenosis. Macdonald et. al reported that parent vessel occlusion can occur up to 1,5 years after. <h3>Methods</h3> We present a case of a patient in their 50s with very delayed parent vessel occlusion after flow diversion treatment for a giant fusiform M2 aneurysm. The occlusion was successfully recanalized, but re-in-stent-thrombosis followed. Initially, the aneurysm was clipped in 2010, with regular follow-ups. However, due to the increase in its size a decade later, the patient underwent endovascular treatment with placement of a single Derivo-flowdiverter stent in the M1/M2 segments. Follow-up MRI and DSA controls at 3, 9 and 18 months showed decreased aneurysm size. Due to non-response to Clopidogrel, they received 100mg Aspirin and 90 mg Ticagrelor, discontinuing the latter after 6 months. 20 months after the initial treatment, they presented with mild right-sided hemiparesis and aphasia (NIHSS 4, ASPECTS 9) due to the flow diverter occlusion. Recanalization with TICI3 outcome was achieved and a continuous 12-hour Tirofiban therapy was initiated. However, after extubation, five hours following the recanalization, they exhibited global aphasia and right-sided hemiparesis (NIHSS 15). A recurrent flow diverter occlusion along with infarct demarcation were observed, leading to no further endovascular therapy. Since the initial endovascular treatment, continuous regimen of Aspirin has been maintained. <h3>Conclusion</h3> Very delayed in-stent thrombosis and subsequent parent vessel occlusion can occur after flow diversion procedures. <h3>Disclosure of Interest</h3> AK: Nothing to disclose MB: Consultant for Microvention, Cerenovus, Acandis, and Rapid JF: The Co-author reports personal fees from Consultant for Acandis, Cerenovus, Medtronic, Microvention, Phenox, Penumbra, Roche, Tonbridge outside of the submitted work. He is a member of the Executive Board of the scientific societies DGNR and the President of ESMINT and holds Stock in Vastrax LLC and Tegus." @default.
- W4386032359 created "2023-08-22" @default.
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- W4386032359 date "2023-08-21" @default.
- W4386032359 modified "2023-09-26" @default.
- W4386032359 title "P012/110 Flow diversion in a giant fusiform M2 aneurysm: very delayed parent vessel occlusion and post-thrombectomy re-in-stent thrombosis" @default.
- W4386032359 doi "https://doi.org/10.1136/jnis-2023-esmint.48" @default.
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