J Korean Neurosurg Soc.  2013 Jun;53(6):360-363. 10.3340/jkns.2013.53.6.360.

Inadvertent Self-Detachment of Solitaire AB Stent during the Mechanical Thrombectomy for Recanalization of Acute Ischemic Stroke: Lessons Learned from the Removal of Stent via Surgical Embolectomy

• Kang DH
• Park J
• Hwang YH
• Kim YS

• KMID: 2190824
• DOI: http://doi.org/10.3340/jkns.2013.53.6.360

Abstract

We recently experienced self-detachment of the Solitaire stent during mechanical thrombectomy of acute ischemic stroke. Then, we tried to remove the detached stent and to recanalize the occlusion, but failed with endovascular means. The following diffusion weighted image MRI revealed no significant increase in infarction size, therefore, we performed surgical removal of the stent to rescue the patient and to elucidate the reason why the self-detachment occurred. Based upon the operative findings, the stent grabbed the main thrombi but inadvertently detached at a severely tortuous, acutely angled, and circumferentially calcified segment of the internal carotid artery. Postoperative angiography demonstrated complete recanalization of the internal carotid artery. The patient's neurological deficits gradually improved, and the modified Rankin scale score was 2 at three months after surgery. In the retrospective case review, bone window images of the baseline computed tomography (CT) scan corresponded to the operative findings. According to this finding, we hypothesized that bone window images of a baseline CT scan can play a role in terms of anticipating difficult stent retrieval before the procedure.

Keyword

CT scan; Thrombectomy; Self-detachment; Stent; Stroke

MeSH Terms

Angiography
Carotid Artery, Internal
Diffusion
Embolectomy
Humans
Infarction
Retrospective Studies
Stents
Stroke
Thrombectomy

Figure

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  Fig. 1 Baseline images of the patient including (A) CT scan, (B) diffusion-weighted image MRI, and (C) mean transit time map of MRI are showing.

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  Fig. 2 A: Angiography shows occlusion at cavernous segment of the internal carotid artery on the right. B: A-P angiography shows that Solitaire AB stent is used as a temporary bypass for the remaining middle cerebral artery occlusion after recanalization of the ICA. C: Final lateral angiography shows inadvertent detachment of the stent and the remaining distal ICA occlusion. ICA: internal carotid artery.

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  Fig. 3 Surgical finding of the acutely angled and circumferentially calcified distal ICA (A) before arteriotomy is showing. Surgically removed Solitaire AB stent is containing the main thrombi at the distal part of the stent strut (B). A-P and lateral angiography immediately after surgery is showing full recanalization of the occlusion (C and D). Bone window image of a baseline CT scan shows severely and circumferentially calcified supraclinoid segment of the ICA (arrow), which corresponds to the surgical finding (E). ICA: internal carotid artery.

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