PMC10400909_01
A 50-year-old woman with an unruptured internal carotid-ophthalmic artery aneurysm. The maximum size and neck size of the aneurysm was 8.0 mm and 4.9 mm, respectively. The ophthalmic artery (blue arrow in A) branched from the dome of the aneurysm. (A and B) Initial 3D reconstruction of DSA and (C) DSA in the working angle. Based on the diameter of the ICA proximal (3.8 mm) and distal (3.6 mm) to the aneurysm, a 4.0-mm-diameter and 18-mm-long FRED was deployed across the neck of the aneurysm. The yellow arrows indicate the distal and proximal flared ends of the FRED, respectively (D). Post-deployment angiography revealed a little intra-aneurysm contrast stagnation (blue arrow) after the treatment. (E). Except for the proximal part (proximal flair) of the FRED, complete expansion of the FRED was confirmed using cone-beam CTA (F). FRED: flow-redirection endoluminal device; ICA: internal carotid artery
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F1
The ophthalmic artery branched from the dome of the aneurysm (Fig. 1A and 1B). A Headway27 microcatheter (MicroVention) was navigated using a microguidewire (ASAHI CHIKAI 14; Asahi Intecc, Aichi, Japan) (Fig. 1C). A 4.0-mm-diameter and 18-mm-long FRED was adequately deployed through the microcatheter across the neck of the aneurysm under appropriate therapeutic heparinization (Fig. 1D). Post-deployment angiography revealed little intra-aneurysm contrast stagnation following FRED deployment (Fig. 1E). Percutaneous transluminal angioplasty (PTA) was not performed because PTA towards the proximal part of the FRED could result in shortening of the stent leading to unstable positioning of the stent (Fig. 1F).
Angiogram obtained 12 months after the treatment demonstrated a complete aneurysm. (A) 3D reconstruction of DSA and (B) DSA. Distal migration and shortening of the FRED stent were revealed, resulting in incomplete coverage of the aneurysm neck. The yellow arrows indicate the distal and proximal flared ends of the FRED, respectively. (C) Digital angiogram and (D) 3D reconstruction of cone-beam CTA. Lateral skull X-ray taken 1 day after the treatment demonstrated that the migration of the stent had already occurred. The yellow arrows indicate the distal and proximal flared ends of the FRED, respectively (E). Signal loss due to the stent artifact in MRA 1 day after the treatment did not span the portion where it was originally deployed (blue arrow) but began at the proximal neck of the aneurysm (white arrow), indicating that the migration of the stent had already occurred (F). FRED: flow-redirection endoluminal device
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F2
Angiography revealed that the aneurysm was not occluded (Fig. 2A and 2B). Distal migration and shortening of the FRED were confirmed, resulting in incomplete coverage of the aneurysm neck (Fig. 2C and 2D). Skull X-rays 1 day after the treatment already demonstrated the migration of the FRED, although we did not recognize this complication (Fig. 2E). The MRA 1 day after the treatment also demonstrated the phenomenon: the signal loss area attributed to the stent artifact in MRA began from the proximal neck of the aneurysm, which revealed that the proximal edge of the FRED had already migrated from the original portion (Fig. 2F).
Second treatment using FRED. Angiogram in the working angle image before the second treatment (A). A 4.0-mm-diameter and 23-mm-long FRED was deployed in an overlapping fashion from the part (green arrow) just proximal to the distal edge of the first FRED stent. The yellow arrows show the distal and proximal flared ends of the first FRED, respectively. The red circle shows the tip of the microcatheter for the second FRED deployment (B). Lastly, the second FRED was deployed up to the proximal part of the carotid siphon. The yellow arrows show the distal and proximal flared ends of the first FRED, respectively. The green arrows show the distal and proximal flared ends of the second FRED, respectively (C). Full expansion of the FRED stents was confirmed using cone-beam CTA (D). Skull X-ray images 1 day after the treatment did not show any obvious migration or shortening of the FRED stents (E). The MRA 1 day after the treatment also demonstrated signal loss spanning the proximal part of the carotid siphon (blue arrow), indicating no obvious migration of the stents (F). FRED: flow-redirection endoluminal device
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F3
A 4.0-mm-diameter and 23-mm-long FRED was deployed in an overlapping fashion up to the proximal part of the carotid siphon using the same device systems as the first treatment (Fig. 3A-3C). Complete expansion of the FRED was again confirmed using cone-beam CTA (Fig. 3D). Skull X-ray images taken 1 day after the treatment did not show any obvious migration or shortening of the FRED stents (Fig. 3E). MRA 1 day after the treatment also demonstrated signal loss spanning the proximal part of the carotid siphon, indicating no obvious migration of the stents (Fig. 3F).