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Case Reports
. 2023 Jul 22;18(10):3453-3456.
doi: 10.1016/j.radcr.2023.07.010. eCollection 2023 Oct.

In-stent stenosis after stenting the PulseRider for a middle cerebral artery aneurysm: A case report

Marina Sakata  1 , Yosuke Tajima  1 , Masaaki Kubota  1 , Yasuo Iwadate  1
Affiliations
Case Reports

In-stent stenosis after stenting the PulseRider for a middle cerebral artery aneurysm: A case report

Marina Sakata et al. Radiol Case Rep. .

Abstract

PulseRider is a self-expanding stent implant used to treat wide-necked aneurysms. As this device has a lower metal mass than conventional stents, it is expected to have a lower rate of ischemic complications and a shorter period with antiplatelet drugs. We experienced in-stent stenosis after endovascular treatment with the PulseRider for a middle cerebral artery aneurysm. A 40-year-old woman with an unruptured aneurysm in the middle cerebral artery bifurcation underwent coil embolization using a PulseRider. The periprocedural course was not problematic, and postoperative angiography showed contrast filling in the aneurysm. The patient was discharged from our hospital on postembolization day 3. However, follow-up angiography after 6 months showed in-stent stenosis. Fortunately, no ischemic complications occurred after treatment. Although the PulseRider is characterized by a low metal mass, it should be noted that this device has some metal markers that can induce in-stent stenosis.

Keywords: Cerebral aneurysm; In-stent stenosis; PulseRider.

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Figures

Fig 1
Fig. 1
(A) Left common carotid angiography in anteroposterior view indicates a saccular aneurysm located in the left middle cerebral artery bifurcation. (B) 3-dimensional rotational angiography (3D-RA) indicates a daughter sac (white arrow). (C) 3D-RA shows that both MCA M2 superior trunk and inferior trunk were incorporated into the aneurysm wall and bifurcated laterally.
Fig 2
Fig. 2
(A) The cone-beam computed tomography (CBCT) before detachment demonstrates the 2 arches of the PulseRider were positioned within both M2 trunks of left MCA and that the aneurysmal neck was covered (white arrowheads). (B) CBCT shows the markers of PulseRider that cohere the vessel wall (white arrows).
Fig 3
Fig 3
(A) Left common carotid angiography after coil embolization shows contrast filling in the aneurysm. (B) There is no stenosis in the left middle cerebral artery.
Fig 4
Fig 4
(A) Follow-up angiography showed complete occlusion of the aneurysm. (B) There is a mild stenosis due to intimal hyperplasia near the medial markers of PulseRider (white arrows).
See this image and copyright information in PMC

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