Recurrent reversible in-stent-stenosis after flow diverter treatment

Area of Science:

• Neurology
• Interventional Neuroradiology
• Biomedical Engineering

Background:

• Flow diverter stents (FDS) are advanced endovascular devices used for treating complex intracranial aneurysms.
• While effective, FDS are associated with specific complications, including in-stent stenosis (ISS).
• ISS is typically observed as a reversible condition that often resolves spontaneously over time.

Observation:

• This report details a patient in their 30s treated with FDS for bilateral paraophthalmic internal carotid artery aneurysms.
• Early follow-up revealed reversible ISS in both treated arteries.
• Remarkably, ISS recurred in both arteries during later follow-up periods, despite prior resolution.

Findings:

• The primary finding is the novel observation of recurrent in-stent stenosis (ISS) after its spontaneous resolution in a patient treated with flow diverter stents.
• This recurrence pattern has not been previously documented in the literature.
• The patient's ISS resolved spontaneously following both the initial occurrence and the recurrence.

Implications:

• The recurrence of ISS after resolution warrants systematic investigation to understand its incidence and natural history.
• Further research into the mechanisms underlying FDS-induced ISS is crucial.
• This understanding may refine treatment strategies and improve patient outcomes for intracranial aneurysms treated with FDS.