title: Reverse waffle cone technique in management of stent dislodgement into intracranial aneurysms.
abstract: Stent-assisted coil embolization (SACE) is a common method to manage intracranial wide-neck aneurysm. Using this technique, a stent must be successfully deployed into the parent artery to cross the aneurysm neck. We describe the reverse waffle cone technique in management of intra-procedural stent dislodgement during SACE of internal carotid artery (ICA) wide-neck aneurysms. Two patients with unruptured wide-neck ICA aneurysms underwent SACE. Intra-procedural forward stent migration occurred during catheterization with proximal stent dislodgement and migration into the aneurysm sac. Navigation of a second stent to bridge the aneurysm neck failed in one patient because the second stent was impeded by the dislodged stent. Using the reverse waffle cone technique, a microcatheter was navigated into the aneurysm sacs. Coils were safely detached into each aneurysm sac without any device assistance. The two wide-neck aneurysms were successfully treated with preservation of flow to the internal carotid arteries. The complication of intra-procedural distal stent migration and dislodgement, with proximal stent prolapse into an aneurysm sac, may not result in a failure to coil the aneurysm. The reverse waffle cone technique provides an effective treatment in the management of this complication.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, 201, Shih-Pai Road, Sec. 2, Beitou, Taipei, Taiwan. cbluo@vghtpe.gov.tw
authors.forename: Chao-Bao
authors.initials: CB
authors.lastname: Luo
authors.forename: Yen-Jun
authors.initials: YJ
authors.lastname: Lai
authors.forename: Michael Mu-Huo
authors.initials: MM
authors.lastname: Teng
authors.forename: Feng-Chi
authors.initials: FC
authors.lastname: Chang
authors.forename: Chung-Jung
authors.initials: CJ
authors.lastname: Lin
authors.forename: Wan-Yuo
authors.initials: WY
authors.lastname: Guo
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D011859:Radiography; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Complication; Endovascular embolization; Intracranial aneurysm; Stent