High-Flow Extracranial-to-Intracranial Bypass for Treatment of Thrombotic Parent Vessel Occlusion After Stent-Assisted Aneurysm Coiling as a Potential Rescue Therapy

Abstract

Introduction: Stent thrombosis (ST) is a known complication after intracranial stent implantation. The pathophysiology of ST is multifactorial, and standardized treatments for ST remain uncertain.

Case description: A patient harboring an unruptured aneurysm of the posterior communicating segment of the left internal carotid artery was treated with stent-assisted coil embolization while on dual antiaggregation therapy. Despite adherence to medication, ST occurred 8 days after the intervention. Following tirofiban infusion, the thrombus dissolved and clinical symptoms improved. However, after tirofiban was stopped, the patient experienced again ischemic symptoms. The patient underwent high-flow extracranial-to-intracranial bypass with good patency of the graft and resolution of symptoms.

Conclusions: In case of refractory ST, high-flow extracranial-to-intracranial bypass proved to be in this case a feasible and effective rescue option.

Keywords: HF EC–IC bypass; In-stent thrombosis; Stent-assisted coiling; Tirofiban.