Starling, r., abouelleil, m., miley, j., & carlson, a.P.(2020).Stent-retriever thrombectomy through an occluded pipeline embolization device.Interdisciplinary neurosurgery, 20, 100659.Doi: 10.1016/j.Inat.2019.100659.Medtronic literature review found a report of in-stent thrombosis after pipeline (ped) implantation.The patient underwent ped implantation in the treatment of a 20-mm broad-necked paraclinoid aneurysm.The patient was placed in dual antiplatelets post-procedurally.Six months post-procedure, the patient's clopidogrel was discontinued by the treating physician.The patient then presented to the emergency department approximately seven hours after onset of dysarthria, left-sided facial droop, and left hemi-plegia.Cta demonstrated internal cerebral artery (ica) occlusion from the cervical bifurcation to just distal to the ped with filling of the middle cerebral artery (mca) from the anterior communicating artery (acom).The patient was started on an eptifibatide drip.An emergent magnetic resonance imaging (mri) with perfusion sequencing was performed, which demonstrated small scattered punctate areas of diffusion restriction.The patient underwent emergency thrombectomy achieving tici 3 revascularization and a small residual non-occlusive thrombus within the ped.Post-procedure day 1, the patient had a persistent minor facial droop but had otherwise made a near complete neurological recovery.Follow up mri demonstrated only tiny scattered infarcts, similar to the pre-procedure study.Post-procedure day 5, diagnostic catheter angiogram was done which demonstrated improvement in the residual thrombus and a small amount of filling of the aneurysm.The patient was discharged on aspirin and clopidogrel with plan for a 6 month follow-up angiogram.
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