Natural course of extensive intimal hyperplasia after aneurysm-treatment with a flowdiverter

THE CASE

Patient 

• 38-year-old female patient
• Vertigo
• incidental finding in MRI
  • Left-sided supraophthalmic
  • Dysplastic-sacciform aneurysm

Supraophthalmic aneurysm

Treatment: Derivo 2 (Acandis) 4mm x 15mm

pre-interventional anticoagulation:

100mg ASA and 75mg Clopidogrel for 10 days

Postinterventional DSA

Interventional treatment (PTA, Stent)?

• Sufficient collateralization over right ICA and expected intimal reaction after another PTA-treatment
  => No intervention but short-term follow-up  
  => Continue DAPT

Follow up

• Patient refused DSA-controls.
• pCASL (pseudo-continuous Arterial Spin Labeling) + TRANCE (Triggered Angiography Non-Contrast Enhanced)+ Doppler ultrasound 

TRANCE 

Supply of right and stenosed left ICA

pCASL and Doppler ultrasound 

MRI prior to hospital discharge as baseline.

intermittent scotoma on the left eye, pulse synchronous bruit, headache resolved completely.

During follow-up-period:

• No neurological deficits
• No cerebral infarction
• No embolism

Dopler ultrasound: Flow-velocity of proximal left M1-segment

Stopping Clopidogrel after 15 months due to monthly anemia while menstruation.

Hemodynamic changes

Conclusion 

Intimal hyperplasia as potential complication after FD-treatment :

• Extensive hemodynamic changes in short-term follow-up
• Adaption of anticoagulation-regimen

FU-Imaging :

• pCASL, TRANCE, Doppler ultrasound are sufficient non-invasive methods for follow-up in certain circumstances