title: Very late thrombosis of a pipeline embolization device construct: case report.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Stony Brook University Medical Center, Department of Neurosurgery, Cerebrovascular Center, Stony Brook, New York, USA. dfiorella@notes.cc.sunysb.edu
authors.forename: David
authors.initials: D
authors.lastname: Fiorella
authors.forename: Daniel
authors.initials: D
authors.lastname: Hsu
authors.forename: Henry H
authors.initials: HH
authors.lastname: Woo
authors.forename: Robert W
authors.initials: RW
authors.lastname: Tarr
authors.forename: Peter Kim
authors.initials: PK
authors.lastname: Nelson
mesh_terms: D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology / Q000628:therapy*; D011100:Polyglycolic Acid / Q000627:therapeutic use; D020521:Stroke / Q000150:complications; D014711:Vertebral Artery / Q000601:surgery
chemical_list: D011100:Polyglycolic Acid