Refractory In-Stent Stenosis After Flow Diverter Stenting Associated With
Ischemic stroke J NeuroIntervent Surg: first published as 10.1136/neurintsurg-2021-017948 on 25 August 2021. Downloaded from Case report Refractory in- stent stenosis after flow diverter stenting associated with delayed cobalt allergic reaction Shoko Fujii,1 Kyohei Fujita ,1 Hiroto Yamaoka,1 Kazunori Miki,1 Sakyo Hirai,1 Shigeru Nemoto,1,2 Kazutaka Sumita 1 1Department of Endovascular SUMMARY TREATMENT Surgery, Tokyo Medical and In- stent stenosis (ISS) triggered by a metal- induced She received dual antiplatelet therapy with acetyl- Dental University, Bunkyo- ku, Japan allergic reaction of Pipeline embolization device (PED) salicylic acid (100 mg/day) and clopidogrel (75 mg/ 2Department of Neurosurgery, placement is extremely rare. The present report describes day), 2 weeks before the procedure. Antiplatelet Kanto Rosai Hospital, a patient who presented with delayed parent artery activity was checked using VerifyNow assay Yokohama, Japan occlusion and refractory ISS after PED placement due (Accumetrics, San Diego, California, USA) the to cobalt allergy. A patient in her 70s underwent PED day before the procedure, and antiplatelet effects Correspondence to placement for a right internal carotid artery (ICA) were confirmed to be optimal. The procedure was Dr Kazutaka Sumita, Department of Endovascular large aneurysm; 4 months later, the patient presented performed under general anesthesia and systemic Surgery, Tokyo Medical and with left- sided hemiparesis, and MRI revealed right heparinization. After deployment of PED, coil Dental University, Bunkyo- ku, ICA occlusion even though antiplatelet therapy was embolization was additionally performed using bare Tokyo, Japan; sumita. nsrg@ optimal. She underwent mechanical thrombectomy, platinum coil (figure 1D–F). She was discharged on tmd.
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