Neurointervention.  2018 Mar;13(1):58-61. 10.5469/neuroint.2018.13.1.58.

Kinking of Flow Diverter in a Giant Wide-Necked Supraclinoid Internal Carotid Artery Aneurysm

• Das S
• Gupta AK
• Ramalingiah AH

• KMID: 2424051
• DOI: http://doi.org/10.5469/neuroint.2018.13.1.58

Abstract

We report here a rare complication in the form of kinking of flow diverter in a case of giant wide-necked supraclinoid internal carotid artery (ICA) aneurysm 48 hours after the procedure. This 28-year female presented with giant wide-necked right supraclinoid ICA aneurysm which was managed by flow diversion. On 2nd post-op day, patient developed weakness of left side with altered sensorium - angiography and CT showed kinking of flow diverter at the neck of the aneurysm with poor distal flow. Eventually, the patient developed right middle cerebral artery infarct for which decompressive hemicraniectomy was done. The likely cause of development of kink is because the aneurysm was wide-necked, the hemodynamic forces have resulted in inward buckling of the flow diverter at the aneurysm neck. This case shows that kinking of flow diverter can still happen 48 hours post-procedure.

Keyword

Kinking; Flow diverter; Giant aneurysm

MeSH Terms

Aneurysm*
Angiography
Carotid Artery, Internal*
Female
Hemodynamics
Humans
Middle Cerebral Artery
Neck

Figure

• 

  Fig. 1 (A, B) Right internal carotid angiogram both AP and lateral views show giant right supraclinoid internal carotid artery (ICA) aneurysm. (C, D) Embolization with coil and deployment of FRED done. Subsequent angiogram showed patency of FRED with slowing of circulation in the aneurysm sac. (E, F) Post-procedure left internal carotid and left vertebral artery angiogram revealed opacification of all intracranial vessels.

• 

  Fig. 2 (A) Immediate post-procedure check CT shows complete opening of flow diverter. (B) CT scan done 48 hours post-procedure for evaluation of neurological deterioration shows kinking of flow diverter (black arrow). (C, D) Right internal carotid angiogram on 2nd post-op day showed kinking of flow diverter at the neck of the aneurysm with poor distal flow. (E) CT scan showing right MCA infarct with kinked flow diverter (black arrow) for which decompressive hemicraniectomy was done.

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