Kanazawa Ryuzaburo, Uchida Takanori, Higashida Tetsuhiro, Kuniyoshi Noboru
Neurosurgery, Tokyo General Hospital, Tokyo, JPN.
Neurosurgery, Nagareyama Central Hospital, Chiba, JPN.
Cureus. 2024 Oct 18;16(10):e71755. doi: 10.7759/cureus.71755. eCollection 2024 Oct.
Neuroform Atlas (NFA; Stryker Neurovascular, Fremont, CA, USA) is a useful and safe device for the treatment of broad-necked and unruptured cerebral aneurysms. Rarely does a proximal shift of both the stent and delivery catheter occur during deployment, and it can be complex to treat. We present two cases in which an NFA that had migrated proximally during deployment was successfully retrieved. In Case 1, a left internal carotid artery (ICA) and posterior communicating artery (Pcom A) bifurcation aneurysm of 12.8 mm in maximum diameter was treated by the stent-assisted technique. An NFA stent (4 ´ 21 mm) was selected for use after placement of three coils. During deployment of the stent from the left Pcom to the ICA, withdrawal of the system in the proximal direction resulted in part of the stent falling into the aneurysm. The half-released stent was retrieved carefully because we considered that complete deployment of the stent would result in inadequate treatment and fatal consequences in the long term. After Case 1, an experiment was conducted to determine whether it was safe to retrieve the NFA into the parent catheter. In Case 2, we experienced the same situation during the procedure of an anterior communicating artery aneurysm. Based on the experience of Case 1, we were able to perform stent retrieval in Case 2 without hesitation. The sudden withdrawal of an NFA stent can occur during the placement procedure. If surgeons encounter proximal migration during NFA deployment, retrieval of the NFA may be an option.
Neuroform Atlas（NFA；史赛克神经血管公司，美国加利福尼亚州弗里蒙特）是一种用于治疗宽颈未破裂脑动脉瘤的有效且安全的装置。在展开过程中，支架和输送导管很少会同时向近端移位，且治疗起来可能很复杂。我们报告两例在展开过程中向近端移位的NFA被成功取出的病例。病例1中，采用支架辅助技术治疗了一例最大直径为12.8 mm的左侧颈内动脉（ICA）和后交通动脉（Pcom A）分叉处动脉瘤。在放置三个弹簧圈后，选用了一个NFA支架（4×21 mm）。在从左侧Pcom向ICA展开支架的过程中，向近端回撤系统导致部分支架落入动脉瘤内。由于我们认为支架完全展开从长远来看会导致治疗不充分并产生致命后果，所以小心地取出了半释放的支架。在病例1之后，进行了一项实验以确定将NFA取回至母导管是否安全。在病例2中，在前交通动脉瘤手术过程中我们遇到了相同的情况。基于病例1的经验，我们在病例2中毫不犹豫地进行了支架取出操作。在放置过程中可能会突然出现NFA支架回撤的情况。如果外科医生在NFA展开过程中遇到向近端移位，取出NFA可能是一种选择。
