Very late @entity715 of flow-diverting constructs after the treatment of large fusiform posterior circulation XXXX .

@entity1 @entity64 @entity41 @entity1397 @entity117 @entity134 @entity439 @entity1188 @entity432 @entity715 @entity10 @entity130
BACKGROUND AND PURPOSE: The PED is a new endoluminal construct designed to exclude @entity439 from the parent cerebrovasculature. We report the very late (>1 year) @entity715 of PED constructs in 2 @entity1 . RESULTS: Two @entity1 with very large fusiform basilar trunk @entity439 underwent parent artery reconstruction with the PED. Both @entity1 were maintained on dual antiplatelet therapy throughout the first year following treatment. Follow-up conventional angiography, performed 12 months after treatment, demonstrated, in both @entity1 , @entity715 of most of the @entity439 with minimal residual flow through the construct and into the @entity439 fundus. In response to the @entity41 , @entity1397 was discontinued ( @entity117 therapy was maintained). Both @entity1 presented with symptomatic acute occlusions of the PED constructs within 14 days of @entity1397 discontinuation. DISCUSSION: @entity1 1 presented with constitutional symptoms that progressed to severe @entity10 without other neurologic signs or symptoms. Occlusion of the PED construct was confirmed with conventional angiography. MR imaging demonstrated no evidence of @entity1188 or @entity130 . The @entity10 were managed successfully with @entity134 therapy. @entity1 2 presented with a syndrome of @entity432 with @entity64 . Complete occlusion was confirmed on angiography. Emergent thrombolysis with mechanical revascularization was performed successfully; however, the @entity1 ultimately succumbed to the @entity1188 . CONCLUSIONS: It appears that flow-diverting constructs built across large circumferential @entity439 may remain thrombogenic for much longer than conventional intracranial or peripheral bare metal stents. Constructs in these @entity1 may remain susceptible to very late @entity715 , >1 year after implantation. These @entity1 likely require long-term dual antiplatelet therapy (>1 year) to provide adequate prophylaxis against @entity715 . If these types of @entity439 demonstrate persistent @entity41 months after PED reconstruction, operators should consider the placement of additional devices as an alternative to the discontinuation of 1 of the antiplatelet medications.
