Bartley Mitchell1, Liang-Der Jou2, Michel Mawad3. 1. Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden, Suite 750, Houston, TX 77030, USA. 2. Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. 3. Neurovascular Center, St. Luke's Episcopal Hospital, Houston, TX 77030, USA ; Department of Neuro-Interventional Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Abstract
BACKGROUND: Flow-diverter stents are increasingly being used in the endovascular treatment of intracranial aneurysms. Because of this increased usage, the occurrence of stent malpositioning, intra-arterial distortion, or migration will likely increase as well. METHODS: We describe the conformational twisting and deformity of a pipeline embolic device (PED) stent (Covidien, EV3) within the carotid artery during stent placement, with the subsequent immediate removal of the stent by using an endovascular snare-loop to successfully remove the device. RESULTS: The PED can be successfully removed using a snare-loop device when indicated. In this case, following removal of the initial PED, the aneurysms can be successfully treated with the placement of a second PED. CONCLUSION: It is critical to have a contingency plan for the removal of malpositioned or otherwise deformed stents that could potentially represent significant sources of iatrogenic stroke.
BACKGROUND: Flow-diverter stents are increasingly being used in the endovascular treatment of intracranial aneurysms. Because of this increased usage, the occurrence of stent malpositioning, intra-arterial distortion, or migration will likely increase as well. METHODS: We describe the conformational twisting and deformity of a pipeline embolic device (PED) stent (Covidien, EV3) within the carotid artery during stent placement, with the subsequent immediate removal of the stent by using an endovascular snare-loop to successfully remove the device. RESULTS: The PED can be successfully removed using a snare-loop device when indicated. In this case, following removal of the initial PED, the aneurysms can be successfully treated with the placement of a second PED. CONCLUSION: It is critical to have a contingency plan for the removal of malpositioned or otherwise deformed stents that could potentially represent significant sources of iatrogenic stroke.
Authors: Mario Martínez-Galdámez; Joaquin Ortega-Quintanilla; Antonio Hermosín; Eduardo Crespo-Vallejo; Juan José Ailagas; Santiago Pérez Journal: BMJ Case Rep Date: 2016-03-23
Authors: Bharathi D Jagadeesan; Divyajot Sandhu; Kim Jae Hong; Sara Roshan Khanipour; Andrew W Grande; Ramachandra P Tummala Journal: Interv Neurol Date: 2016-11-11