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KMID : 1155820210160030285
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Neurointervention
2021 Volume.16 No. 3 p.285 ~ p.292
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Treatment of In-Stent Stenosis Following Flow Diversion of Intracranial Aneurysms with Cilostazol and Clopidogrel
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Dowlati Ehsan
Pasko Kory B. Dylan
Liu Jiaqi
Miller Charles A.
Felbaum Daniel R.
Sur Samir
Chang Jason J.
Liu Ai-Hsi
Armonda Rocco A.
Mai Jeffrey C.
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Abstract
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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.
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KEYWORD
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Endovascular procedures, Intracranial aneurysm, Stents, Cilostazol, Clopidogrel, Aspirin
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