R D Fessler1, A J Ringer, A I Qureshi, L R Guterman, L N Hopkins. 1. Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo School of Medicine and Biomedical Sciences, The State University of New York, 14209-1194, USA.
Abstract
OBJECTIVE: The development of low profile, navigable stents has expanded the range of intracranial neuroendovascular procedures. We report a unique case of endovascular stent placement to trap a partially extruded Guglielmi detachable coil (GDC) during treatment of an internal carotid artery (ICA) cavernous segment aneurysm. METHODS: A 49-year-old woman presented for endovascular coiling of a left superior hypophyseal artery aneurysm. Previously, a contralateral mirror lesion had been treated by stent-assisted coiling. Heparin was administered to maintain an activated coagulation time of greater than 250 seconds, and a guide catheter was placed in the cervical ICA. A microcatheter was advanced into the aneurysm over a microguidewire. A GDC-10, 3-dimension, 6 x 20-mm coil was placed within the aneurysm, forming a stable basket. Three additional GDCs were placed with near-complete obliteration of the aneurysm. Attempted placement of a fifth coil caused partial prolapse of a previously placed coil into the cavernous ICA. We decided to place a stent rather than to snare the extruded coil because the extruded coil was integral to the aneurysm coil mass. A 3.5x8-mm balloon-expandable stent was placed across the aneurysm orifice, trapping the extruded coil between the stent and ICA. RESULTS: Digital subtraction angiography documented patency of the ICA lumen. The patient remains neurologically intact and awaits 3-month follow-up cerebral angiography. CONCLUSION: Trapping of an extruded intraaneurysmal coil via stent placement obviated the need for coil removal and avoided the risk of coil mass manipulation. The use of a stent to displace extruded coils and reconstitute a "normal" lumen is an excellent addition to our endovascular armamentarium.
OBJECTIVE: The development of low profile, navigable stents has expanded the range of intracranial neuroendovascular procedures. We report a unique case of endovascular stent placement to trap a partially extruded Guglielmi detachable coil (GDC) during treatment of an internal carotid artery (ICA) cavernous segment aneurysm. METHODS: A 49-year-old woman presented for endovascular coiling of a left superior hypophyseal artery aneurysm. Previously, a contralateral mirror lesion had been treated by stent-assisted coiling. Heparin was administered to maintain an activated coagulation time of greater than 250 seconds, and a guide catheter was placed in the cervical ICA. A microcatheter was advanced into the aneurysm over a microguidewire. A GDC-10, 3-dimension, 6 x 20-mm coil was placed within the aneurysm, forming a stable basket. Three additional GDCs were placed with near-complete obliteration of the aneurysm. Attempted placement of a fifth coil caused partial prolapse of a previously placed coil into the cavernous ICA. We decided to place a stent rather than to snare the extruded coil because the extruded coil was integral to the aneurysm coil mass. A 3.5x8-mm balloon-expandable stent was placed across the aneurysm orifice, trapping the extruded coil between the stent and ICA. RESULTS: Digital subtraction angiography documented patency of the ICA lumen. The patient remains neurologically intact and awaits 3-month follow-up cerebral angiography. CONCLUSION: Trapping of an extruded intraaneurysmal coil via stent placement obviated the need for coil removal and avoided the risk of coil mass manipulation. The use of a stent to displace extruded coils and reconstitute a "normal" lumen is an excellent addition to our endovascular armamentarium.
Authors: Stephanie H Chen; Ramesh Grandhi; Christopher P Deibert; Tudor G Jovin; Paul A Gardner; Andrew F Ducruet Journal: Interv Neuroradiol Date: 2015-05-01 Impact factor: 1.610