Document Detail


Very late thrombosis of a pipeline embolization device construct: case report.
MedLine Citation:
PMID:  20679914     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Pipeline embolization device (PED) is a new endoluminal construct designed to exclude aneurysms from the parent cerebrovasculature. We report the very late (>1 year) thrombosis of a PED construct placed for the treatment of a left vertebral aneurysm.
CLINICAL PRESENTATION: A patient with an occluded right vertebral artery and a large, fusiform intracranial left vertebral artery aneurysm was treated with PED and coil reconstruction. A durable, complete occlusion of the aneurysm was confirmed with control angiography at 1 year. The patient remained neurologically normal for 23 months until he experienced a transient visual disturbance followed weeks later by a minor brainstem stroke.
INTERVENTION: Imaging evaluation showed thrombosis of the PED construct with complete occlusion of the left vertebral artery. After this stroke, he was initially treated with dual antiplatelet therapy and was then converted to warfarin. The patient remained neurologically stable for 5 months until he experienced progressive basilar thrombosis that ultimately resulted in a fatal stroke.
CONCLUSION: The PED represents a promising new endovascular technology for the treatment of cerebral aneurysms; however, as an investigational device, long-term follow-up data are sparse at this point. The etiology of the very late thrombosis of the PED construct in this case remains unknown; however, this report underscores the need for a continued, careful systematic evaluation and close long-term follow-up of treated patients.
Authors:
David Fiorella; Daniel Hsu; Henry H Woo; Robert W Tarr; Peter Kim Nelson
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  67     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-23     Completed Date:  2010-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  onsE313-4; discussion onsE314     Citation Subset:  IM    
Affiliation:
Stony Brook University Medical Center, Department of Neurosurgery, Cerebrovascular Center, Stony Brook, New York, USA. dfiorella@notes.cc.sunysb.edu
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MeSH Terms
Descriptor/Qualifier:
Cerebral Angiography / methods
Embolization, Therapeutic / methods*
Follow-Up Studies
Humans
Intracranial Aneurysm / etiology,  therapy*
Polyglycolic Acid / therapeutic use
Stroke / complications
Vertebral Artery / surgery
Chemical
Reg. No./Substance:
26009-03-0/Polyglycolic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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