Stent-retriever thrombectomy through an occluded pipeline embolization device

Abstract

A 71-year-old female with a history of a right medial paraclinoid aneurysm was treated with pipeline embolization device and placed on dual antiplatelet therapy for 6 months. Clopidogrel was discontinued at 6 months, and the patient developed dysarthria, left-hemiplegia, and left-sided facial droop two days later. A CT angiogram demonstrated thrombus formation in the pipeline embolization device resulting in complete carotid occlusion. She presented greater than 6 h from onset and so no rt-PA was given. An eptifibatide bolus and drip was started. The patient was taken for mechanical thrombectomy given a favorable MR-perfusion pattern. Despite very tenacious clot within the device, successful revascularization was achieved using a stent retriever in the device. Keywords: Mechanical thrombectomy, Stent-retriever, In-stent thrombosis, Pipeline embolization device