Mechanical Thrombectomy for Delayed Thrombosis of Pipeline Embolization Device

Matthew B. Potts*, Michael C. Hurley, Sameer A. Ansari, Ali Shaibani, Scott R. Geraghty, Thomas J. Grobelny, Babak S. Jahromi

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: In-stent thrombosis is a potentially dangerous complication of flow diversion for cerebral aneurysms. The optimal management strategy for such thrombosis is not known. Here we present a case of acute ischemic stroke caused by occlusion of a Pipeline Embolization Device (PED) construct placed 18 months earlier for treatment of a fusiform middle cerebral artery aneurysm. This was successfully treated with mechanical thrombectomy with good neurologic outcome. Case Description: A 40-year-old woman presented with acute onset of left-sided weakness and occlusion of the right middle cerebral artery harboring a PED construct. Intraarterial glycoprotein IIb/IIIa inhibitor was administered without success. Mechanical thrombectomy was then performed using a stent retriever and aspiration, and the patient was loaded with dual antiplatelet therapy. The patient showed initial neurologic improvement but several hours later demonstrated recurrent symptoms due to reocclusion of the PED construct. This was again treated with mechanical thrombectomy followed by an intravenous P2Y12 inhibitor infusion. She ultimately made an excellent neurologic recovery with persistent patency of the PED construct. Conclusions: Mechanical thrombectomy with a stent retriever and aspiration is a therapeutic option for treatment of delayed thrombosis of a flow-diverting stent.

Original languageEnglish (US)
Pages (from-to)237-240
Number of pages4
JournalWorld neurosurgery
Volume140
DOIs
StatePublished - Aug 2020

Keywords

  • Aneurysm
  • Flow diversion
  • Pipeline Embolization Device
  • Stent retriever
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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