Emergency Intra-Arterial Thrombolysis for Parent Artery Thrombosis After Stent-Assisted Coiling of a Middle Cerebral Artery Aneurysm.

OBJECTIVE

To investigate the risk factors, diagnosis, and the safety and efficacy of emergency intra-arterial thrombolysis for acute occlusion of the parent artery following stent-assisted coil embolization.

METHODS

The authors report a case of a 58-year-old male with a right middle cerebral artery aneurysm who underwent stent-assisted coil embolization. Immediate postprocedural angiography confirmed dense aneurysm packing with patency of the parent artery. Two hours postoperation, the patient acutely developed left-sided hemiparesis and aphasia. Emergency angiography revealed acute in-stent thrombosis of the right middle cerebral artery, prompting urgent intra-arterial thrombolysis with tirofiban. This case is discussed alongside a literature review to explore the diagnostic and therapeutic strategies for secondary thrombosis following stent-assisted embolization of intracranial aneurysms.

RESULTS

Post-thrombolysis angiography demonstrated complete recanalization of the parent artery. The patient's neurological symptoms improved rapidly without new neurological deficits, and follow-up indicated a favorable outcome. The literature suggests that although this complication is rare, it is critical, and timely diagnosis and intervention are crucial for improving prognosis.

CONCLUSIONS

Acute in-stent thrombosis is a severe complication of stent-assisted coil embolization. When strict indications are met, emergency intra-arterial thrombolysis is an effective rescue therapy. Perioperative intensive antiplatelet therapy, meticulous angiographic monitoring during the procedure, and early postoperative recognition coupled with prompt intra-arterial thrombolysis are central to achieving successful revascularization and improving clinical outcomes.