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Early angiographic signs of acute thrombus formation following cerebral aneurysm treatment with the Pipeline embolization device
  1. Akil Patel1,
  2. Timothy R Miller2,
  3. Ravi Shivashankar2,
  4. Gaurav Jindal2,
  5. Dheeraj Gandhi2
  1. 1Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
  2. 2Department of Diagnostic Radiology, Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA
  1. Correspondence to Dr Timothy R Miller, Department of Radiology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA; tmiller5{at}umm.edu

Abstract

Background and objective Acute thrombus formation following aneurysm treatment with the Pipeline embolization device (PED) is a potentially devastating complication that may result in significant thromboembolic sequelae if not promptly treated. We therefore evaluated PED cases complicated by acute thrombus formation at our institution, with an emphasis on identifying early angiographic signs that may portend this event.

Materials and methods We retrospectively identified cases of acute thrombosis following PED placement in 100 consecutive procedures performed at our institution from a prospectively maintained clinical database. Angiographic findings were analyzed for early signs of acute thrombus formation. We also evaluated the efficacy of treatment of this complication with a glycoprotein IIb/IIIa inhibitor (abciximab), as well as the results of pre-procedure platelet inhibition testing.

Results Acute thrombus formation was encountered in five patients following PED placement (5%). Early angiographic signs were present in all cases and included progressive stagnation of blood flow in covered side branches, occlusion of covered side branches, excessive stagnation of blood flow in the target aneurysm, as well as occlusion of the target aneurysm. These sequelae completely resolved following abciximab treatment in all five cases, with no permanent neurological morbidity or mortality. Four of the five patients had a pre-procedure P2Y12 value >200 (range 201–227).

Conclusions Progressive stagnation or occlusion of covered side branches or target aneurysm are early angiographic signs of acute thrombus formation following PED placement and should prompt immediate treatment with a glycoprotein IIb/IIIa inhibitor. Platelet inhibition testing may help identify those patients who are at an increased risk for this complication.

  • Aneurysm
  • Complication
  • Flow Diverter
  • Embolic
  • Stroke
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Footnotes

  • Contributors AP: Acquired and analyzed data, prepared draft of manuscript. TRM: Acquired and analyzed data, prepared draft of manuscript, revised manuscript. RS: Acquired and analyzed data. GJ: Revised manuscript. DG: Acquired and analyzed data, revised manuscript.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the University of Maryland IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors are willing to share spreadsheets from their data acquisition and experimental set-up details on request.

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