Matthew b.Potts, michael c.Hurley, sameer a.Ansari, ali shaibani, scott r.Geraghty, thomas j.Grobelny, babak s.Jahromi, mechanical thrombectomy for delayed thrombosis of pipeline embolization device, world neurosurgery, volume 140, 2020, pages 237-240, issn 1878-8750, https://doi.Org/10.1016/j.Wneu.2020.04.202.Medtronic literature review found reported of patient complications in association with implantation of a pipeline embolization device (ped).The authors reviewed one case of a (b)(6), female patient treated for an unruptured fusiform aneurysm using a ped.The procedure was off-label due to the location of the implantation.The article does not state any technical issues during use of the pipeline.Six months post-procedure, occlusion of the aneurysm was confirmed via cerebral angiogram.Eighteen months post-procedure, the patient presented with acute onset of left-side weakness and a national institutes of health stroke scale (nihss) score of 10.At the time of her presentation with an acute ischemic stroke, computed tomography (ct) angiography demonstrated occlusion within the ped construct and ct perfusion showed a large region of ischemic penumbra within the right mca territory.A mechanical thrombectomy was performed, and reperfusion was achieved with a 2a reperfusion score.Two hours later, reocclusion of the ped was demonstrated.Another mechanical thrombectomy was performed and the modified thrombolysis in cerebral infarction (mtici) score was 2a again.The patient was put on dual antiplatelet therapy (dapt) with aspirin 81 mg daily and ticagrelor 90 mg twice daily.The patient remained neurologically intact and remained so at the 1 year follow up.
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