Ohshima Tomotaka, Belayev Andrey, Goto Shunsaku, Yamamoto Taiki, Ishikawa Kojiro, Kato Yoko
Department of Neurosurgery, Kariya Toyota General Hospital, Aich, Japan.
Department of Neurosurgery, Raleigh Neurosurgical Clinic, NC, USA.
Nagoya J Med Sci. 2017 Feb;79(2):267-272. doi: 10.18999/nagjms.79.2.267.
Stent migration is a complication associated with endovascular coil embolization of intracranial aneurysms. We report a case of anterior communicating artery (ACoA) aneurysm that was successfully treated after stent migration during endovascular coil embolization without retrieval of the stent. A 47-year-old man presented with sudden onset severe headache. Patient was noted to have subarachnoid hemorrhage from a ruptured ACoA aneurysm. Emergency endovascular coil embolization was performed. The second coil embolization was scheduled for the neck-remnant portion with a stent after 16 days from the initial operation. At first, a stent was deployed from the right perpendicular division of anterior cerebral artery (A2) to the left horizontal division of anterior cerebral artery (A1) entirely across the aneurysmal neck. Although the stent position looked fine, the stent migrated inferiorly to the proximal A1 portion when its delivery wire was withdrawn. Fortunately, the stent could be pushed into the distal A1 portion, when we trying to re-access the aneurysm thorough the stent with a pig-tail shaped microguidewire. Additional coil embolization was achieved using the assistance of distal tip of the stent as a scaffold of the coil. The patient was discharged without any complication on the postoperative day 6. Although there are various choices of rescue treatment after stent migration, this is the first reported case of stent repositioning with a microguidewire. Our technique may represent an effective option in case of stent migration.
支架移位是颅内动脉瘤血管内弹簧圈栓塞术的一种并发症。我们报告一例前交通动脉瘤病例，该病例在血管内弹簧圈栓塞术期间发生支架移位后，未取出支架而成功治愈。一名47岁男性突发剧烈头痛。经检查发现患者因前交通动脉瘤破裂导致蛛网膜下腔出血。遂进行了紧急血管内弹簧圈栓塞术。在初次手术后16天，计划对动脉瘤颈部残余部分使用支架进行第二次弹簧圈栓塞。首先，将一枚支架从前交通动脉（A2）右侧垂直段完全跨过动脉瘤颈部，放置到前交通动脉（A1）左侧水平段。尽管支架位置看起来良好，但在撤出输送导丝时，支架向下移位至A1近端部分。幸运的是，当我们尝试用猪尾形微导丝通过支架重新进入动脉瘤时，能够将支架推至A1远端部分。借助支架远端作为弹簧圈的支撑框架，实现了额外的弹簧圈栓塞。患者术后第6天无任何并发症出院。尽管支架移位后有多种补救治疗选择，但这是首例使用微导丝重新定位支架的报道病例。我们的技术可能是支架移位情况下的一种有效选择。
