Tourniquet parent artery occlusion after flow diversion

Abstract

A gradual tourniquet-like occlusion can occur following placement of the PED, leading to vessel occlusion. This has been clinically well tolerated by patients in our series due to the formation of pial collaterals as the stenosis progresses, likely due to ischemic preconditioning. Small parent vessel, pre-existing stenosis, fusiform pathology, overlapping devices, and suboptimal antiplatelet therapy seem to be predisposing factors. Further experience and follow-up will allow us to characterize the risk factors and optimize post-procedural therapy for these patients.

Flow diversion for the treatment of posterior inferior cerebellar artery aneurysms: a novel classification and strategies

“…Jailing of the PICA where the pathology involves the PICA is a unique case, as the involvement of the PICA at the aneurysm neck may lead to treatment failure, as seen in other aneurysms 27 28. We have previously described cases of asymptomatic, delayed occlusion in other small vessels (A2, P2, M1), which we have termed ‘tourniquet’ occlusions 29. The same phenomenon is reproduced in this report, with delayed occlusion of the PICA in case No 3.…”

Letter to the Editor. Hybrid approaches in pediatric neurovascular surgery

“…This may likely be due to progressive stenosis leading to occlusion in a "tourniquet" effect, as we have previously described. 4 In some of the cases in which we encountered this effect, it occurred after reduction of antiplatelet therapy. We commend the authors for sharing their experience with this interesting case and encourage others to consider a similar hybrid approach in such cases.…”

“…We have discussed our standard protocol as applied to FD cases. 4 Even if it may be an inexact science, monitoring a patient's response to antiplatelet medications is important to avoid potential complications, especially when the exposed bare metal burden is quite high, as in the case described. The use of these assays in pediatric FD has been a particular topic of interest as this treatment becomes more common in that population.…”

Hybrid vascular intervention for a giant cervical carotid artery aneurysm in a clopidogrel-hyporesponsive child

“…Finally, the data in the literature regarding flow diversion of aneurysms suggest that delayed stenosis or delayed occlusion of intracranial stents may be associated with induction of distal collateral formation, and when this happens, the patients remain asymptomatic. 17,22 Nevertheless, parent artery sacrifice is a valid treatment option that would have precluded the well-defined albeit relatively small risk of our combined approach.…”