Treatment of In-Stent Stenosis Following Flow Diversion of Intracranial Aneurysms with Cilostazol and Clopidogrel
10.5469euroint.2021.00290
- Author:
Ehsan DOWLATI
1
;
Kory B. Dylan PASKO
;
Jiaqi LIU
;
Charles A. MILLER
;
Daniel R. FELBAUM
;
Samir SUR
;
Jason J. CHANG
;
Ai-Hsi LIU
;
Rocco A. ARMONDA
;
Jeffrey C. MAI
Author Information
1. Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
- Publication Type:Case Report
- From:Neurointervention
2021;16(3):285-292
- CountryRepublic of Korea
- Language:English
-
Abstract:
In-stent stenosis is a feared complication of flow diversion treatment for cerebral aneurysms. We present 2 cases of patients treated with pipeline flow diversion for unruptured cerebral aneurysms. Initial perioperative dual antiplatelet therapy (DAPT) consisted of standard aspirin plus clopidogrel. At 6-month follow-up cerebral angiography, the patients were noted to have developed significant in-stent stenosis (63% and 53%). The patients were treated with cilostazol and clopidogrel for at least 6 months. Subsequent angiography at 1-year post-treatment showed significant improvement of the in-stent stenosis from 63% to 34% and 53% to 21%. The role of cilostazol as treatment of intracranial in-stent stenosis has not been previously described. Cilostazol’s vasodilatory effect and suppression of vascular smooth muscle proliferation provides ideal benefits in this setting. Cilostazol plus clopidogrel may be a safe and effective alternative to standard DAPT for treatment of in-stent stenosis following flow diversion and warrants further consideration and investigation.
