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KMID : 1148420190020020070
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Journal of Neurointensive Care
2019 Volume.2 No. 2 p.70 ~ p.76
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Crescent Sign Following Enterprise-Stent assisted Coil Embolization of Distal Internal Carotid Artery Aneurysms
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Kim Young-Jin
Yeon Je-Young
Kim Jong-Soo
Hong Seung-Chyul
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Abstract
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Objective: We aimed to determine the “significant crescent signs” associated with delayed thromboembolic events (DTE) after changes in antiplatelet medication and to evaluate their incidence and natural course.
Methods: Between April 2009 and April 2011, 105 consecutive patients underwent stent-assisted coil embolization for unruptured intracranial aneurysms (n=107) in a single tertiary hospital. Sixty-three cases fulfilled the inclusion criteria and were included in this study. Crescent sign was evaluated through follow-up magnetic resonance angiography (MRA) immediately (<48 hours), 6 to 12 months, 1 to 2 years, and 2 to 4 years and correlated with the occurrence of DTE.
Results: Crescent signs were identified in 26 (41.3%) of 63 cases on immediate follow-up MRA. During the mean radiological follow-up of 53 months, the crescent signs (larger than 5 mm in length) persisted for more than 1 year in 11 (42.3%) of 26 cases. The crescent signs on follow-up MRA showed decreased size in 10 of 26 cases and disappeared in 5 cases. DTE occurred in 6 (9.5%) of 63 cases. In these 6 cases, all DTE occurred when the antiplatelet regimen was changed or stopped. Five of these six cases exhibited a crescent sign measuring over 5 mm in length, at the time of stroke.
Conclusions: Crescent signs may be associated with DTE. When crescent signs are larger than 5 mm in length and continuously identified on follow-up MRA, continued dual antiplatelet treatment is required.
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KEYWORD
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Intracranial Aneurysm, Self Expandable Metal Stent, Therapeutic Embolization, Antiplatelet Drugs
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