• Eiji Higashi, Taketo Hatano, Mitsushige Ando, Hideo Chihara, Takenori Ogura, Keita Suzuki, Keitaro Yamagami, Daisuke Kondo, Takahiko Kamata, Shota Sakai, Hiroki Sakamoto, and Izumi Nagata.
• Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Fukuoka, Japan. Electronic address: eiji0016788@gmail.com.
• World Neurosurg. 2019 Nov 1; 131: 209-212.

BackgroundAntiplatelet agents are typically administered before and after treatment using flow-diverter stents (FDS) to prevent thrombotic complications, but the effects of anticoagulants are unclear. We present a patient with a giant aneurysm treated with an FDS. The thrombus within the aneurysm was dissolved when a direct factor Xa inhibitor was administered to treat lower limb venous thrombosis that occurred secondary to steroid use.Case DescriptionA 60-year-old woman with a 30-mm giant thrombosed aneurysm in the cavernous segment of the right internal carotid artery presenting with headache and right abducens nerve palsy was treated by placing an FDS. Diplopia and increased pain in her right eye appeared on postoperative day 7, and both were alleviated by continuous oral administration of prednisolone. Angiography 3 months postoperatively revealed that the aneurysm thrombosis had progressed, and there were signs of healing. However, at the same time, lower limb venous thrombosis occurred, which was treated by continuous edoxaban. Six months after surgery, her headaches worsened and angiography showed that the aneurysm was again contrast enhanced and that the thrombus within the aneurysm had dissolved. After discontinuing edoxaban 9 months after surgery, the aneurysmal thrombosis had again rapidly progressed.ConclusionsAdministration of a direct factor Xa inhibitor during healing after placing an FDS may cause dissolution of an existing thrombus; therefore factor Xa inhibitors must be used with caution.Copyright © 2019 Elsevier Inc. All rights reserved.

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