I've seen perhaps 10 patients like this over the past 6-7 years. All of the events began shortly after decreasing from Brilinta/ASA dual therapy (which is standard for a few months after flow diverter placement) to ASA monotherapy. Like Drew, the exam has been invariably normal and with a benign course, though we've put them all back on dual antiplatelet therapy. The events have almost invariably resolved promptly after resumption of dual antiplatelet therapy and I've had almost no success with verapamil or nifedipine. Usually we've given it 3-6 months and tried to wean antiplatelets again, often with eventual success. I've never obtained a TCD, which could be interesting.
That said, my patients have all had flow diverting stents placed in the ICA proximal to or across the ophthalmic artery's origin, so your patient's situation might be different since it sounds like it's perhaps only the PComm which has the flow diverter.
All the best,
Marc Bouffard
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