Kanazawa Ryuzaburo, Uchida Takanori, Higashida Tetsuhiro, Kono Takao, Ebise Hiroki, Kuniyoshi Noboru
Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan.
Department of General Internal Medicine, Nagareyama Central Hospital, Chiba, Japan.
Surg Neurol Int. 2024 Aug 9;15:278. doi: 10.25259/SNI_513_2024. eCollection 2024.
A flow redirection endoluminal device (FRED) is a widely used flow diverter stent. Although high technical success and good treatment results were reported in the SAFE study, cases of technical failure of deployment have also been reported. A case in which a FRED was deployed with the proximal part twisted, but successful deployment was achieved, is presented.
A woman in her 40s was diagnosed with a left internal carotid artery aneurysm during radiological investigations for headaches. Due to her family's strong history of cerebral aneurysms, she opted for preventive treatment. A 5.5-mm FRED was selected because the proximal vessel diameter was ≥5 mm. However, the stent was deployed with the proximal side twisted. Fortunately, using a Scepter C and a CHIKAI 315 cm, the true lumen could be secure, the wire was guided distally, and the FRED was successfully placed. Later, with the patient's consent, a 3D blood vessel model was created, and whether the stent was difficult to open or whether it was just a technical problem which was verified experimentally. Precisely, the same situation as during the surgery was recreated, and the stent was deployed in the same way.
A FRED is an effective device, but there are cases of difficult deployment. The present method may be an option if a FRED is difficult to open.
血流导向腔内装置（FRED）是一种广泛使用的血流分流支架。尽管在SAFE研究中报告了较高的技术成功率和良好的治疗效果，但也有部署技术失败的病例报道。本文介绍了一例FRED近端扭曲但成功部署的病例。
一名40多岁的女性在因头痛进行影像学检查时被诊断为左颈内动脉瘤。由于其家族有强烈的脑动脉瘤病史，她选择了预防性治疗。由于近端血管直径≥5mm，选择了5.5mm的FRED。然而，支架在部署时近端发生扭曲。幸运的是，使用Scepter C和CHIKAI 315cm，真腔得以确保，导丝被向远端引导，FRED成功放置。后来，在患者同意的情况下，创建了一个三维血管模型，并通过实验验证了支架是难以打开还是仅仅是一个技术问题。确切地说，重现了与手术期间相同的情况，并以相同的方式部署了支架。
FRED是一种有效的装置，但存在部署困难的情况。如果FRED难以打开，本方法可能是一种选择。
