Edgar A Samaniego1, Sudeepta Dandapat2, Jorge A Roa2, Mario Zanaty3, Daichi Nakagawa3, David M Hasan3. 1. Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. 2. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. 3. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Abstract
BACKGROUND: Embolization of intracranial aneurysms with the pipeline embolization device (PED; Medtronic, Dublin, Ireland) is a widely used technique. Despite adequate dual antiplatelet therapy and intraprocedural anticoagulation, in-stent thrombosis has been described. There is limited evidence for best management of this complication. OBJECTIVE: To describe in detail the technique used to perform thrombectomy of a recently placed PED with in-stent thrombosis. The aim of the procedure is to leave the PED in place and only perform thrombectomy of the luminal clot. METHODS: We describe two cases of successful thrombectomy with a stentriever of acutely occluded PEDs. A total of 2 patients underwent PED embolization of 2 previously clipped aneurysms. Despite optimal deployment of the PEDs and excellent angiographic results, both patients developed symptoms of right hemispheric stroke within 1 h of the procedure. A thrombectomy was performed in each patient with the stentriever within the newly deployed PED. Thrombectomy was successful and there was no evidence of PED displacement of vascular injury. RESULTS: Stentriever thrombectomy of intraluminal clot can be performed effectively when the entire stentriever device is deployed within the PED. We did not experience any PED displacement, vessel damage, spasm, or device malfunction using this technique. CONCLUSION: We report the use of a stentriever to perform thrombectomy for in-stent thrombosis after PED placement as an additional treatment option of acute occlusion. This technique has not been previously described.
BACKGROUND: Embolization of intracranial aneurysms with the pipeline embolization device (PED; Medtronic, Dublin, Ireland) is a widely used technique. Despite adequate dual antiplatelet therapy and intraprocedural anticoagulation, in-stent thrombosis has been described. There is limited evidence for best management of this complication. OBJECTIVE: To describe in detail the technique used to perform thrombectomy of a recently placed PED with in-stent thrombosis. The aim of the procedure is to leave the PED in place and only perform thrombectomy of the luminal clot. METHODS: We describe two cases of successful thrombectomy with a stentriever of acutely occluded PEDs. A total of 2 patients underwent PED embolization of 2 previously clipped aneurysms. Despite optimal deployment of the PEDs and excellent angiographic results, both patients developed symptoms of right hemispheric stroke within 1 h of the procedure. A thrombectomy was performed in each patient with the stentriever within the newly deployed PED. Thrombectomy was successful and there was no evidence of PED displacement of vascular injury. RESULTS: Stentriever thrombectomy of intraluminal clot can be performed effectively when the entire stentriever device is deployed within the PED. We did not experience any PED displacement, vessel damage, spasm, or device malfunction using this technique. CONCLUSION: We report the use of a stentriever to perform thrombectomy for in-stent thrombosis after PED placement as an additional treatment option of acute occlusion. This technique has not been previously described.
Authors: Tibor Becske; Waleed Brinjikji; Matthew B Potts; David F Kallmes; Maksim Shapiro; Christopher J Moran; Elad I Levy; Cameron G McDougall; István Szikora; Giuseppe Lanzino; Henry H Woo; Demetrius K Lopes; Adnan H Siddiqui; Felipe C Albuquerque; David J Fiorella; Isil Saatci; Saruhan H Cekirge; Aaron L Berez; Daniel J Cher; Zsolt Berentei; Miklós Marosfoi; Peter K Nelson Journal: Neurosurgery Date: 2017-01-01 Impact factor: 4.654
Authors: Nimer Adeeb; Christoph J Griessenauer; Justin M Moore; Paul M Foreman; Hussain Shallwani; Rouzbeh Motiei-Langroudi; Raghav Gupta; Carlos E Baccin; Abdulrahman Alturki; Mark R Harrigan; Adnan H Siddiqui; Elad I Levy; Christopher S Ogilvy; Ajith J Thomas Journal: Stroke Date: 2017-02-28 Impact factor: 7.914
Authors: Tibor Becske; David F Kallmes; Isil Saatci; Cameron G McDougall; István Szikora; Giuseppe Lanzino; Christopher J Moran; Henry H Woo; Demetrius K Lopes; Aaron L Berez; Daniel J Cher; Adnan H Siddiqui; Elad I Levy; Felipe C Albuquerque; David J Fiorella; Zsolt Berentei; Miklós Marosfoi; Saruhan H Cekirge; Peter K Nelson Journal: Radiology Date: 2013-02-15 Impact factor: 11.105
Authors: Mario Zanaty; Badih Daou; Nohra Chalouhi; Robert M Starke; Edgar Samaniego; Colin Derdeyn; Pascal Jabbour; David Hasan Journal: World Neurosurg Date: 2016-08-23 Impact factor: 2.104
Authors: Akash P Kansagra; James D McEachern; Thomas P Madaelil; Adam N Wallace; DeWitte T Cross; Christopher J Moran; Colin P Derdeyn Journal: J Neurointerv Surg Date: 2016-08-18 Impact factor: 5.836
Authors: Waldo R Guerrero; Santiago Ortega-Gutierrez; Minako Hayakawa; Colin P Derdeyn; James D Rossen; David Hasan; Edgar A Samaniego Journal: World Neurosurg Date: 2017-10-05 Impact factor: 2.104