{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:48:54Z","timestamp":1772110134974,"version":"3.50.1"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"18","license":[{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,10,28]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Iatrogenic vertebral artery injury during surgery can cause pseudoaneurysm, hemorrhage, thrombosis, ischemia, or death. Strategies to prevent cerebrovascular embolic complications include surgical ligation, endovascular stenting, and\/or antiplatelet therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 73-year-old female with a known right vertebral artery occlusion underwent a C2\u20133 laminectomy, complicated by left vertebral artery injury and occlusion with subsequent posterior circulation ischemia. She underwent immediate angioplasty and stenting of the injured artery with undersized drug-eluting stents. Dual antiplatelet therapy of aspirin 81 mg daily and ticagrelor 90 mg twice daily was initiated. On two occasions, more than 6 months after stenting, holding a single ticagrelor dose led to in-stent thrombosis and embolic stroke within hours of the missed dose. Lifelong therapy with ticagrelor was favored over further procedural intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>It is recommended to prioritize optimal wall stent apposition with oversized stents in patients without collateral circulation. The risk of thromboembolism due to poorly apposed stents is very high, even in delayed (&gt; 6 months) settings. Stent construct revision or bypass grafting may not be feasible or desirable options. For patients without wall apposition, endothelialization may not occur, necessitating lifelong P2Y12 inhibitor therapy to prevent recurrent thromboembolic events.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24296\">https:\/\/thejns.org\/doi\/10.3171\/CASE24296<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24296","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T02:44:28Z","timestamp":1730083468000},"source":"Crossref","is-referenced-by-count":1,"title":["Hyperacute thrombosis of a vertebral artery stent with a single missed dose of a P2Y12 inhibitor and poor stent wall apposition: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Misa","family":"Trieu","sequence":"first","affiliation":[{"name":"Cooper Medical School of Rowan University, Camden, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manisha","family":"Koneru","sequence":"additional","affiliation":[{"name":"Cooper Medical School of Rowan University, Camden, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Departments of Neurology, Cooper University Health Care, Camden, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Santucci","sequence":"additional","affiliation":[{"name":"Departments of Neurology, Cooper University Health Care, Camden, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pratit","family":"Patel","sequence":"additional","affiliation":[{"name":"Cooper Medical School of Rowan University, Camden, New Jersey"},{"name":"Departments of Neurology, Cooper University Health Care, Camden, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Khalife","sequence":"additional","affiliation":[{"name":"Cooper Medical School of Rowan University, Camden, New Jersey"},{"name":"Departments of Neurology, Cooper University Health Care, Camden, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamza A","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Cooper Medical School of Rowan University, Camden, New Jersey"},{"name":"Departments of Neurosurgery, Cooper University Health Care, Camden, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel A","family":"Tonetti","sequence":"additional","affiliation":[{"name":"Cooper Medical School of Rowan University, Camden, New Jersey"},{"name":"Departments of Neurosurgery, Cooper University Health Care, Camden, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Spine J","first-page":"70","article-title":"Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures","volume":"9","author":"Peng","year":"2009","unstructured":"Peng CWChou BTBendo JASpivak JM. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J. 2009;9(1):70-76."},{"key":"bib2","series-title":"World Neurosurg","first-page":"83","article-title":"Iatrogenic vascular injury associated with cervical spine surgery: a systematic literature review","volume":"159","author":"Turgut","year":"2022","unstructured":"Turgut MAkhaddar ATurgut ATHall WA. Iatrogenic vascular injury associated with cervical spine surgery: a systematic literature review. World Neurosurg. 2022;159:83-106."},{"issue":"2","key":"bib3","series-title":"AJR Am J Roentgenol","first-page":"443","article-title":"Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences","volume":"164","author":"Friedman","year":"1995","unstructured":"Friedman DFlanders AThomas CMillar W. Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences. AJR Am J Roentgenol. 1995;164(2):443-449."},{"issue":"6","key":"bib4","series-title":"Acta Neurol Scand","first-page":"398","article-title":"Hypoplasia, stenosis and other alterations of the vertebral artery: does impaired blood rheology manifest a hidden disease?","volume":"97","author":"Oder","year":"1998","unstructured":"Oder BOder WLang WMarschnigg EDeecke L. Hypoplasia, stenosis and other alterations of the vertebral artery: does impaired blood rheology manifest a hidden disease? Acta Neurol Scand. 1998;97(6):398-403."},{"issue":"4","key":"bib5","series-title":"Eur Neurol","first-page":"193","article-title":"Toward a further elucidation: role of vertebral artery hypoplasia in acute ischemic stroke","volume":"55","author":"Chuang","year":"2006","unstructured":"Chuang YMHuang YCHu HHYang CY. Toward a further elucidation: role of vertebral artery hypoplasia in acute ischemic stroke. Eur Neurol. 2006;55(4):193-197."},{"issue":"1","key":"bib6","series-title":"Neurology","first-page":"65","article-title":"Vertebral artery hypoplasia: a predisposing factor for posterior circulation stroke?","volume":"68","author":"Perren","year":"2007","unstructured":"Perren FPoglia DLandis TSztajzel R. Vertebral artery hypoplasia: a predisposing factor for posterior circulation stroke? Neurology. 2007;68(1):65-67."},{"issue":"22","key":"bib7","series-title":"Spine (Phila Pa 1976)","first-page":"2552","article-title":"Repair of vertebral artery injury during anterior cervical decompression","volume":"19","author":"Golfinos","year":"1994","unstructured":"Golfinos JGDickman CAZabramski JMSonntag VKSpetzler RF. Repair of vertebral artery injury during anterior cervical decompression. Spine (Phila Pa 1976). 1994;19(22):2552-2556."},{"issue":"25","key":"bib8","series-title":"Circulation","first-page":"2577","article-title":"Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET\/OFFSET study","volume":"120","author":"Gurbel","year":"2009","unstructured":"Gurbel PABliden KPButler K, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET\/OFFSET study. Circulation. 2009;120(25):2577-2585."},{"issue":"23","key":"bib9","series-title":"N Engl J Med","first-page":"2155","article-title":"Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents","volume":"371","author":"Mauri","year":"2014","unstructured":"Mauri LKereiakes DJYeh RW, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014;371(23):2155-2166."},{"issue":"1","key":"bib1","series-title":"Spine J","first-page":"70","article-title":"Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures","volume":"9","author":"Peng","year":"2009","unstructured":"Peng CWChou BTBendo JASpivak JM. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J. 2009;9(1):70-76."},{"key":"bib2","series-title":"World Neurosurg","first-page":"83","article-title":"Iatrogenic vascular injury associated with cervical spine surgery: a systematic literature review","volume":"159","author":"Turgut","year":"2022","unstructured":"Turgut MAkhaddar ATurgut ATHall WA. Iatrogenic vascular injury associated with cervical spine surgery: a systematic literature review. World Neurosurg. 2022;159:83-106."},{"issue":"2","key":"bib3","series-title":"AJR Am J Roentgenol","first-page":"443","article-title":"Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences","volume":"164","author":"Friedman","year":"1995","unstructured":"Friedman DFlanders AThomas CMillar W. Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences. AJR Am J Roentgenol. 1995;164(2):443-449."},{"issue":"6","key":"bib4","series-title":"Acta Neurol Scand","first-page":"398","article-title":"Hypoplasia, stenosis and other alterations of the vertebral artery: does impaired blood rheology manifest a hidden disease?","volume":"97","author":"Oder","year":"1998","unstructured":"Oder BOder WLang WMarschnigg EDeecke L. Hypoplasia, stenosis and other alterations of the vertebral artery: does impaired blood rheology manifest a hidden disease? Acta Neurol Scand. 1998;97(6):398-403."},{"issue":"4","key":"bib5","series-title":"Eur Neurol","first-page":"193","article-title":"Toward a further elucidation: role of vertebral artery hypoplasia in acute ischemic stroke","volume":"55","author":"Chuang","year":"2006","unstructured":"Chuang YMHuang YCHu HHYang CY. Toward a further elucidation: role of vertebral artery hypoplasia in acute ischemic stroke. Eur Neurol. 2006;55(4):193-197."},{"issue":"1","key":"bib6","series-title":"Neurology","first-page":"65","article-title":"Vertebral artery hypoplasia: a predisposing factor for posterior circulation stroke?","volume":"68","author":"Perren","year":"2007","unstructured":"Perren FPoglia DLandis TSztajzel R. Vertebral artery hypoplasia: a predisposing factor for posterior circulation stroke? Neurology. 2007;68(1):65-67."},{"issue":"22","key":"bib7","series-title":"Spine (Phila Pa 1976)","first-page":"2552","article-title":"Repair of vertebral artery injury during anterior cervical decompression","volume":"19","author":"Golfinos","year":"1994","unstructured":"Golfinos JGDickman CAZabramski JMSonntag VKSpetzler RF. Repair of vertebral artery injury during anterior cervical decompression. Spine (Phila Pa 1976). 1994;19(22):2552-2556."},{"issue":"25","key":"bib8","series-title":"Circulation","first-page":"2577","article-title":"Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET\/OFFSET study","volume":"120","author":"Gurbel","year":"2009","unstructured":"Gurbel PABliden KPButler K, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET\/OFFSET study. Circulation. 2009;120(25):2577-2585."},{"issue":"23","key":"bib9","series-title":"N Engl J Med","first-page":"2155","article-title":"Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents","volume":"371","author":"Mauri","year":"2014","unstructured":"Mauri LKereiakes DJYeh RW, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014;371(23):2155-2166."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/8\/18\/article-CASE24296.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/8\/18\/article-CASE24296.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/8\/18\/article-CASE24296.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:57:44Z","timestamp":1769687864000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/8\/18\/article-CASE24296.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,28]]},"references-count":18,"journal-issue":{"issue":"18"},"URL":"https:\/\/doi.org\/10.3171\/case24296","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,28]]}}}