Departments of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA.
Departments of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA.
World Neurosurg. 2020 Aug;140:237-240. doi: 10.1016/j.wneu.2020.04.202. Epub 2020 May 5.
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.
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.
Mechanical thrombectomy with a stent retriever and aspiration is a therapeutic option for treatment of delayed thrombosis of a flow-diverting stent.
支架内血栓形成是脑动脉瘤血流导向装置治疗的一种潜在危险并发症。对于这种血栓形成的最佳治疗策略尚不清楚。在此，我们报告了一例 18 个月前因治疗梭形大脑中动脉动脉瘤而放置 Pipeline 栓塞装置（PED）后发生急性缺血性卒中的病例。该患者采用机械血栓切除术成功治疗，神经功能预后良好。
一名 40 岁女性因左侧无力急性发作就诊，右侧大脑中动脉有 PED 装置，血管闭塞。给予血管内糖蛋白 IIb/IIIa 抑制剂治疗，但未成功。随后使用支架取栓器和抽吸进行机械血栓切除术，患者接受双联抗血小板治疗。患者最初神经功能有所改善，但数小时后由于 PED 装置再次闭塞而出现症状复发。再次进行机械血栓切除术，随后静脉内给予 P2Y12 抑制剂输注。最终，患者 PED 装置持续通畅，神经功能恢复良好。
支架取栓器和抽吸的机械血栓切除术是治疗血流导向支架迟发性血栓形成的一种治疗选择。
