Endovascular Rescue Strategies For Non-opening of Flow Diverter: A Case Report
Flow diversion and correction of haemodynamic disturbances are the mainstays of treatment for any intracranial aneurysm. Flow Diverters (FD) are widely accepted as effective treatments for fusiform, wide-necked, large, and giant intracranial aneurysms. Thromboembolic events and intra- and postoperat...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2025-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=August&volume=19&issue=8&page=TD01-TD04&id=21278 |
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| Summary: | Flow diversion and correction of haemodynamic disturbances are the mainstays of treatment for any intracranial aneurysm. Flow Diverters (FD) are widely accepted as effective treatments for fusiform, wide-necked, large, and giant intracranial aneurysms. Thromboembolic events and intra- and postoperative aneurysmal ruptures are the most frequently encountered complications. Rarely, mechanical, anatomical, and technical challenges can result in deployment failure and incomplete opening of an FD. When these devices fail, they can jeopardise the treatment, necessitating immediate rescue strategies to avoid complications. This is a case of a 40-year-old female presenting with chronic headache that acutely worsened over the preceding two days. Computed Tomography (CT) revealed a large aneurysm in the left supraclinoid internal carotid artery (ICA) with a subarachnoid bleed. FD stent placement and partial coil embolisation of the aneurysm was planned. During deployment, the proximal end of the FD failed to open despite employing standard rescue manoeuvres, including ‘waggling’ and intra-catheter unsheathing. Balloon angioplasty using a monorail coronary balloon successfully restored stent patency and wall apposition. The patient had an uneventful recovery and complete aneurysm occlusion at four months’ follow-up angiography. This case highlights the importance of recognising deployment complications and underscores the need for preparedness with advanced endovascular techniques, such as balloon angioplasty, when standard rescue manoeuvres fail. |
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| ISSN: | 2249-782X 0973-709X |