1017. Acute Post-Operative Thrombosis of Pipeline Embolization Device: A Multicenter Case Series

Authors: Robert Kyle Townsend, MD; Kyle Fargen, MD, MPH; Peter Kan, MD; Reade De Leacy, MD; Alejandro Spiotta, MD; Joshua Hirsch, MD; Andrew Ducruet, MD; Aqib Zehri, MD (Winston Salem, NC)

Introduction: Use of flow diversion devices such as the Pipeline Embolization Device (PED) for treatment of intracranial aneurysms has increased in the past decade. This has been demonstrated to be a safe and effective treatment, both on- and off-label for treatment of aneurysms, however some risks do exist. One potential complication is post procedural thrombosis of the PED, which can be devastating if left untreated. There is minimal organized discussion of the incidence and treatment options available for this complication. The goal of the study is to establish the incidence of post-operative symptomatic thrombosis of PED, analyze possible etiologies of thrombosis, and summarize potential endovascular therapies. Methods: We compiled a multicenter case series of acute PED thrombosis which included 768 patients treated at 5 centers over 5 year period from March 2013 to March 2018. Results: There were 10 cases of acute thrombosis over 768 patients treated with a PED, for an incidence of 0.0029 and prevalence of 0.013. Six cases were due to either antiplatelet non-compliance or abnormal platelet function testing unknown at time of discharge. Therapies for treatment included aspiration thrombectomy in 6 cases, stentriever in one case, balloon angioplasty in one case, and reopro infusion alone in one case. Nine patients were discharged with modified rankin score of 1 or less with TICI 3 revascularization in 9 cases and 2c in one case. One patient discharged with mRS of 4. Conclusion: Acute post operative thrombosis is a rare complication of PED placement. For patients who have appreciable neurological deficit from this rare complication we have provided a catalog of potential treatment options which have been used with good outcomes at 5 major institutions.