Neurointervention.  2020 Nov;15(3):154-157. 10.5469/neuroint.2020.00220.

Delayed Proximal Flow Diverting Stent Migration in a Ruptured Intracranial Aneurysm: A Case Report

• Takong W
• Kobkitsuksakul C

• KMID: 2508068
• DOI: http://doi.org/10.5469/neuroint.2020.00220

Abstract

A flow diverter can be used to treat a ruptured aneurysm, especially during complicated cases for endovascular or open microsurgical procedures. However, some complications have been reported such as occlusion of side branches or perforating arteries, stent migration or improper stent position, re-rupture of the aneurysm, and in-stent thrombosis. A 38-year-old man diagnosed with a ruptured left supraclinoid aneurysm was treated with a Pipeline embolization device. Despite adequate stent coverage of the aneurysmal neck, delayed proximal migration was seen in follow-up imaging. To our knowledge, proximal migration of the stent mostly happens intraoperatively due to an undersized stent or excessive stretching. We report a case of delayed proximal flow diverter stent migration.

Keyword

Flow diverter; Stent migration; Ruptured aneurysm

Figure

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  Fig. 1. Thirty-eight years old male with a ruptured aneurysm. (A) Initial angiography showed a tiny wide-neck aneurysm on dorsal wall of internal carotid artery. (B) 3D angiogram immediately after placement of Pipeline embolization device (PED) demonstrated stent covering the neck of aneurysm (although most of stent was placed proximal to the aneurysm). (C) Follow-up angiography at 6 weeks later showed a growing aneurysm with narrow neck. (D) Control angiography after coil embolization demonstrated nearly complete obliteration of the aneurysm. The distal part of PED partially covered narrow neck of aneurysm.

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