Mechanical Thrombectomy for Delayed Thrombosis of Pipeline Embolization Device

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• In-stent thrombosis is a serious complication of flow diversion for cerebral aneurysms.
• Optimal management for delayed thrombosis after flow diverter placement remains unclear.
• This case highlights a delayed occlusion of a Pipeline Embolization Device (PED).

Observation:

• A 40-year-old female presented with acute left-sided weakness due to right middle cerebral artery occlusion by a PED.
• Initial treatment with intra-arterial glycoprotein IIb/IIIa inhibitors was unsuccessful.
• Mechanical thrombectomy using a stent retriever and aspiration led to initial improvement, but reocclusion occurred.

Findings:

• Recurrent thrombosis of the PED construct necessitated a second mechanical thrombectomy.
• Intravenous P2Y12 inhibitor infusion was administered after the second thrombectomy.
• The patient achieved excellent neurologic recovery with sustained PED patency.

Implications:

• Mechanical thrombectomy is a viable therapeutic option for delayed in-stent thrombosis in flow-diverting stents.
• This case highlights the potential efficacy of mechanical thrombectomy in managing acute ischemic events caused by PED occlusion.
• Successful treatment underscores the importance of timely intervention for thrombotic complications of neurovascular devices.