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Research ArticleNeurointervention
Open Access

Postprocedural Thrombosis following Endovascular Treatment of Intracranial Aneurysm with Flow Diverters or Coiling: A Histologic Study

J.A. Larco, M. Abbasi, Y. Liu, D. Dai, G. Lanzino, L.E. Savastano, H. Cloft, D.F. Kallmes, R. Kadirvel and W. Brinjikji
American Journal of Neuroradiology December 2021, DOI: https://doi.org/10.3174/ajnr.A7369
J.A. Larco
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
bNeurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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M. Abbasi
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
bNeurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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Y. Liu
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
bNeurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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D. Dai
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
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G. Lanzino
bNeurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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  • ORCID record for G. Lanzino
L.E. Savastano
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
bNeurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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  • ORCID record for L.E. Savastano
H. Cloft
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
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D.F. Kallmes
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
bNeurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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R. Kadirvel
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
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W. Brinjikji
aFrom the Department of Radiology (J.A.L., M.A., Y.L., D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
bNeurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
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Figures

  • FIG 1.
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    FIG 1.

    Lateral view showing the final positioning of the FD (white arrow) (A), with a post-procedural contrast-enhanced angiogram (B) and the occlusion site that involves the carotid artery (white asterisk) (C). Anterior-posterior view shows the final position of the FD (D), with a postprocedural contrast-enhanced angiogram (E) and the occlusion site that involves the carotid artery (F).

  • FIG 2.
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    FIG 2.

    Staining of the thrombus retrieved from patient 1 showing the structure of the thrombus on H&E staining (A), with a high percentage of RBCs in the thrombus (B, Martius Scarlet Blue, stained yellow, identified with the plus sign). Peripheral expression of neutrophil extracellular traps (CitH3) (C, stained red, identified with the plus sign), vWF (D, stained pink and red, identified with the plus sign), and platelets (CD42b) (E, stained red, identified with the plus sign) in the thrombus.

  • FIG 3.
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    FIG 3.

    FD implantation with coiling (A–E). Anterior-posterior (A) and lateral (B) views of the post- procedural positioning of the coiled aneurysm (white arrows). Anterior-posterior contrast-enhanced angiogram shows postprocedural patency of the vasculature (C). 3D reconstruction and a contrast-enhanced angiogram show the vasculature architecture and a wide-neck right posterior commuting artery aneurysm with an adjacent daughter sac (D and E).

  • FIG 4.
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    FIG 4.

    Staining of the thrombus retrieved from patient 2 showing the structure of the thrombus on H&E staining (A) with a high percentage of RBCs in the thrombus (B, Martius Scarlet Blue, stained yellow, identified with the plus sign). Peripheral expression of neutrophil extracellular traps (CitH3) (C, stained red, identified with the plus sign), vWF (D, stained pink and red, identified with the plus sign), and platelets (CD42b) (E, stained red, identified with the plus sign) in the thrombus.

  • FIG 5.
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    FIG 5.

    Anterior-posterior (A) and lateral (B) views of the postprocedural positioning of the coiled aneurysm (white arrows). Lateral projection of a contrast-enhanced angiogram and the external intraventricular drain shows in the background (C). 3D reconstruction shows the vascular architecture neighboring the lobulated anterior communicating artery aneurysm (D). Anteroposterior DSA projection demonstrates acute large vessel occlusion (E) (white asterisk).

  • FIG 6.
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    FIG 6.

    Staining of the thrombus retrieved from patient 3 showing the structure of thrombus on H&E staining (A) with a high percentage of RBCs in the thrombus (B, Martius Scarlet Blue, stained yellow, identified with the plus sign). Peripheral expression of neutrophil extracellular traps (CitH3) (C, stained red, identified with the plus sign), vWF (D, stained pink and red, identified with the plus sign), and platelets (CD42b) (E, stained red, identified with the plus sign) in the thrombus.

  • FIG 7.
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    FIG 7.

    Anterior-posterior (A) and lateral (B) views of the postprocedural positioning of the coiled aneurysm (white arrows) and the lateral projection of contrast-enhanced DSA (C) showing patency of the artery. 3D reconstruction (D) of the lobulated aneurysm located in the posterior communicating artery. Anterior-posterior DSA (E) projection shows occlusion of M2 (white asterisk).

  • FIG 8.
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    FIG 8.

    Staining of the thrombus retrieved from patient 4 showing the structure of thrombus on H&E staining (A), with a high percentage of RBCs in the thrombus (B, Martius Scarlet Blue, stained yellow, identified with the plus sign). Peripheral expression of neutrophil extracellular traps (CitH3) (C, stained red, identified with the plus sign), vWF (D, stained pink and red, identified with the plus sign), and platelets (CD42b) (E, stained red, identified with the plus sign) in the thrombus.

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Cite this article
J.A. Larco, M. Abbasi, Y. Liu, D. Dai, G. Lanzino, L.E. Savastano, H. Cloft, D.F. Kallmes, R. Kadirvel, W. Brinjikji
Postprocedural Thrombosis following Endovascular Treatment of Intracranial Aneurysm with Flow Diverters or Coiling: A Histologic Study
American Journal of Neuroradiology Dec 2021, DOI: 10.3174/ajnr.A7369

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Postprocedural Thrombosis following Endovascular Treatment of Intracranial Aneurysm with Flow Diverters or Coiling: A Histologic Study
J.A. Larco, M. Abbasi, Y. Liu, D. Dai, G. Lanzino, L.E. Savastano, H. Cloft, D.F. Kallmes, R. Kadirvel, W. Brinjikji
American Journal of Neuroradiology Dec 2021, DOI: 10.3174/ajnr.A7369
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