Nariai Yasuhiko, Takigawa Tomoji, Hyodo Akio, Suzuki Kensuke
Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan.
Department of Neurosurgery, Kamagaya General Hospital, Kamagaya, Chiba, Japan.
J Neuroendovasc Ther. 2023;17(7):132-138. doi: 10.5797/jnet.cr.2023-0011. Epub 2023 May 26.
The flow diverter (FD) is a promising device. Apart from two main complications, hemorrhagic and ischemic ones, stent migration is reportedly an unusual complication. In particular, distal migration of the FD has rarely been reported. We report a case of asymptomatic acute distal migration of the flow-redirection endoluminal device (FRED).
A 50-year-old woman was incidentally diagnosed with an unruptured right internal carotid-ophthalmic artery aneurysm with a maximum diameter of 8.0 mm, and she subsequently underwent endovascular treatment with FRED. Based on the vessel diameter (3.8 mm proximal and 3.6 mm distal to the aneurysm), a 4.0-mm-diameter and 18-mm-long FRED was deployed without postoperative complications. However, on MRA 12 months after treatment, the aneurysm was not occluded; angiography showed distal migration of the FRED. The postoperative MRA and skull X-ray images were retrospectively reviewed to determine the period of the migration. The skull X-ray images and the signal loss area due to the FRED on MRA 1 day after the treatment had already demonstrated the migration of the FRED. In the second treatment, a 4.0-mm-diameter and 23-mm-long FRED was deployed in an overlapping fashion up to the proximal part of the carotid siphon. Prompt identification of distal migration of the FD without neurologic signs could be challenging.
It is important to follow up meticulously with MRA and skull X-ray images after FD treatment for detecting stent migrations as early as possible.
血流导向装置（FD）是一种很有前景的设备。除了出血和缺血这两种主要并发症外，据报道支架移位是一种罕见的并发症。特别是，FD的远端移位很少被报道。我们报告一例血流导向腔内装置（FRED）无症状急性远端移位的病例。
一名50岁女性偶然被诊断出患有未破裂的右颈内动脉-眼动脉瘤，最大直径为8.0mm，随后接受了FRED血管内治疗。根据血管直径（动脉瘤近端3.8mm，远端3.6mm），部署了一个直径4.0mm、长度18mm的FRED，术后无并发症。然而，治疗后12个月的磁共振血管造影（MRA）显示动脉瘤未闭塞；血管造影显示FRED远端移位。回顾性分析术后MRA和颅骨X线图像以确定移位时间。治疗后1天的颅骨X线图像和MRA上FRED导致的信号缺失区域已显示FRED移位。在第二次治疗中，以重叠方式部署了一个直径4.0mm、长度23mm 的FRED，直至颈动脉虹吸部近端。在无神经症状的情况下及时识别FD的远端移位可能具有挑战性。
FD治疗后，通过MRA和颅骨X线图像进行细致的随访，对于尽早发现支架移位很重要。
