Subacute Stent Deformities as an Underlying Reason for Vessel Stenosis after Flow Diversion with the p64 Stent: Review and Discussion of Biologic Mechanisms and Consequences

A and B, antero-posterior (AP) and lateral projections of a single-shot image of the stent on discharge. No deformity was observed. C and D, Single-shot images of the stent 14 days after the procedure, after the onset of symptoms. A noticeable narrowing and elongation of the distal part of the stent can be seen (orange arrow). This observation is concurrent with our observation of the carotid artery’s reaction to the implant. Because this case is the one in which our patient exhibited acute symptoms from the occurrence, we believe it is extremely illustrative for our point to come across. E, AP projection of the intraprocedural DSA performed prior to the implantation of the FD stent. A saccular aneurysm of the ophthalmic segment of the left ICA was the target of treatment. F and G, DWI MRI sequence, which was performed after the initial onset of right-sided weakness with which the patient presented. No acute ischemic changes in the brain parenchyma can be seen, which led us to believe that the changes in the cerebral blood flow were transient in nature.

Six-month DSA control performed on the patient (anteroposterior projections). A severe narrowing of the distal left ICA in the segment of the placed FD and reduced blood flow in the left middle and anterior cerebral arteries can be seen (A). These findings correlate with the symptoms observed in the patient in the first month postprocedure. A compensatory development of leptomeningeal collaterals, collaterals from the posterior circulation and the right ICA, is the probable cause for the lack of vascular incidents during that time (B and C).