Abstract
The Willis covered stent (WCS) may prolapse into the aneurysmal sac due to device migration or foreshortening. We present a useful salvage strategy that can reorient a prolapsed WCS into a more suitable alignment. An intra-procedural prolapse of a WCS into a large cavernous aneurysm occurred in a 70-year-old female patient. A pipeline embolization device (PED) was used to retrieve the WCS and successfully accomplish flow diversion. Maintaining proximal access and ensuring that the microwire is securely held within the central axis of the herniated stent are critical until the entire parent vessel can be reconstructed. This salvage technique may help to regain proximal access and reposition the flow diversion constructs following WCS prolapse.
Highlights
The Willis covered stent (WCS, MicroPort, Shanghai, China) is approved for the treatment of intracranial aneurysms including distal internal carotid artery (ICA) aneurysms, recurrent intracranial aneurysms after coiling, fusiform carotid aneurysms, and large or giant intracranial aneurysms, and it has yielded good outcomes [1,2,3,4,5]
The pipeline embolization device (PED, Medtronic-Covidien Neurovascular, Irvine, CA, USA) is a safe and effective treatment for recurrent intracranial aneurysms following clipping [10], coiling [11], and stent-assisted embolization [8, 12]; its utility in the management of aneurysms previously treated with a WCS that migrated and prolapsed into the aneurysm sac has not been reported
Endoleaks are a frequent complication that can be resolved by balloon reinflation and/or placement of an additional stent
Summary
The Willis covered stent (WCS, MicroPort, Shanghai, China) is approved for the treatment of intracranial aneurysms including distal internal carotid artery (ICA) aneurysms, recurrent intracranial aneurysms after coiling, fusiform carotid aneurysms, and large or giant intracranial aneurysms, and it has yielded good outcomes [1,2,3,4,5]. Compared with incomplete neck coverage, stent prolapse into the aneurysm sac is more problematic because of the difficulty associated with regaining distal or proximal access to reconstruct the parent artery. We describe the first use of a PED to realign proximal access to the previous WCS for secondary reconstruction of the parent artery. Distal migration of the graft occurred upon balloon removal, which led to the proximal part of the stent prolapsing into the aneurysm (Figure 1C). A 300-cm Transend microwire (Stryker, Kalamazoo, MI, USA) with a loop in the tip was passed through the WCS and distal ICA and into the middle cerebral artery (Figures 2B–D). The patient had an uneventful post-operative course and was discharged in good condition after 3 days Her oculomotor paralysis improved within 6 months
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