Seung Won-Bae
Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Republic of Korea.
Case Rep Neurol. 2018 Aug 29;10(2):213-216. doi: 10.1159/000492110. eCollection 2018 May-Aug.
The Solitaire AB Neurovascular Remodeling Device (ev3, Irvine, CA, USA) is used to retain coils within an aneurysm, reducing the risk of embolic complications from coil herniation into the parent artery. Stents are deployed after confirming the optimal position of the stent markers across the aneurysm to avoid entry into perforators or branching arteries. Stent marker position is very important to prevent perforating or branching artery infarction. We performed stent-assisted coil embolization using the Solitaire AB stent to treat 2 aneurysms simultaneously. After successful coil embolization, we detached the Solitaire stent in the usual manner. However, the proximal stent marker, which was located at the horizontal segment of the cavernous internal carotid artery, moved into the meningohypophyseal trunk and occluded it. Although the distal markers were positioned optimally, we did not expect the proximal marker to be in the position where it was located. Fortunately, cranial nerve dysfunctions and pituitary deficiency did not develop. It is important to prevent ischemic injury by occlusion of the perforators or branching vessels that can be caused by malpositioned stent markers. We consider where the proximal marker of the stent might be located after detachment.
Solitaire AB神经血管重塑装置（美国加利福尼亚州欧文市ev3公司生产）用于将弹簧圈留置在动脉瘤内，降低弹簧圈疝入载瘤动脉导致栓塞并发症的风险。在确认支架标记物横跨动脉瘤的最佳位置后再置入支架，以避免进入穿支动脉或分支动脉。支架标记物的位置对于预防穿支动脉或分支动脉梗死非常重要。我们使用Solitaire AB支架进行支架辅助弹簧圈栓塞术，同时治疗2个动脉瘤。弹簧圈栓塞成功后，我们按常规方式解脱Solitaire支架。然而，位于海绵窦段颈内动脉水平段的近端支架标记物移入脑膜垂体干并将其闭塞。尽管远端标记物位置最佳，但我们并未料到近端标记物会处于那样的位置。幸运的是，并未出现脑神经功能障碍和垂体功能减退。防止因支架标记物位置不当导致穿支动脉或分支血管闭塞引起的缺血性损伤很重要。我们会考虑支架解脱后近端标记物可能所处的位置。
