PMC6812692_01
The WCS prolapsed into the aneurysm. (A) A WCS bridged the aneurysm neck under roadmap guidance. (B) Control angiography showed a mild endoleak after WCS placement. (C) Distal migration of the graft occurred with balloon removal, and the proximal part of the stent prolapsed into the aneurysm.
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F1
Using roadmap guidance, a WCS measuring 4.5 x 16.0 mm was bridged into the aneurysm neck (Figure 1A). After that, a mild proximal endoleak was observed (Figure 1B). Worse still, distal migration of the graft occurred upon balloon removal, which led to the proximal part of the stent prolapsing into the aneurysm (Figure 1C).
Key steps of the PED rescue maneuver. (A) Prolapse of the proximal portion of the stent into the aneurysm sac under roadmap guidance. (B-D) A microwire loop is formed in the tip (B), which is then passed through the WCS and distal ICA (C) and into the middle cerebral artery (D). (E) Insufficient opening of the distal PED (asterisk). (F,G) Repeated massage with the microwire facilitated distal PED opening (double asterisks). (H,I) Angiography immediately after the procedure revealed that the contrast agent was trapped in the aneurysm cavity, and the typical "meniscus sign" could be seen.
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F2
The roadmap showed that the proximal part of the device had prolapsed into the aneurysm sac (Figure 2A). 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 microwire was advanced again, due to insufficient opening of the distal PED (Figure 2E). Repeated massage with the microwire encouraged distal PED opening (Figures 2F,G). The final angiographic image demonstrated early aneurysm stasis and good PED wall apposition (Figures 2H,I).