Vladev Georgi, Sirakov Alexander, Sirakova Kristina, Sirakov Sanimir S
Radiology Department, UH St Ivan Rilski, Sofia, Bulgaria.
Radiology Department, UH Alexandrovska, Sofia, Bulgaria.
Interv Neuroradiol. 2025 Feb;31(1):143. doi: 10.1177/15910199221149633. Epub 2022 Dec 30.
Flow diverter stents are increasingly used as the sole endovascular treatment method for complex or wide-necked intracranial aneurysms. Technical complications related to stent deployment are infrequently reported in the literature. During treatment, implant misbehaviors may occur, including incomplete tubular expansion with insufficient aneurysmal coverage and wall apposition, proximal or distal narrowing, and twisting along the axis. Little is known about this phenomenon, especially if it relates to the operator experience, deployment techniques, different devices, and implant properties. The management of these complications requires technical precision and is often remediated by "massaging" the stent with the delivery system, balloon angioplasty, or placement of additional self-expandable stents. Lastly, if critically damaged, the stent could be taken out of the vessel with a combination of maneuvers called "stentectomy." These techniques often necessitate multiple navigations and the utilization of a larger microcatheter. We aim to highlight the feasibility of Comaneci 17 stent-angioplasty as an effective bailout strategy for inadequately deployed flow diverter stents. The suggested approach's technical aspects, including pros and cons, have been discussed.
血流导向支架越来越多地被用作复杂或宽颈颅内动脉瘤的唯一血管内治疗方法。文献中很少报道与支架植入相关的技术并发症。在治疗过程中，可能会出现植入物行为异常，包括管状扩张不完全、动脉瘤覆盖不足和管壁贴合不良、近端或远端狭窄以及沿轴线扭转。人们对这种现象知之甚少，尤其是它是否与操作者经验、植入技术、不同器械和植入物特性有关。这些并发症的处理需要技术精准度，通常通过用输送系统“按摩”支架、球囊血管成形术或放置额外的自膨式支架来补救。最后，如果支架严重受损，可以通过一种称为“支架切除术”的联合操作将其从血管中取出。这些技术通常需要多次操作并使用更大的微导管。我们旨在强调科马内奇17型支架血管成形术作为血流导向支架植入不当的有效补救策略的可行性。已讨论了所建议方法的技术方面，包括优缺点。
