Management of Neuroform Stent Dislodgement and

Summary: A self-expanding stent has recently been intro-duced for the treatment of wide-neck aneurysms. We de-scribe two cases of stent malposition within large aneu-rysms. In the first case, the stent was dislodged during microcatheterization. This was managed by placement of a second stent through the interstices of the first followed by aneurysm coiling. In the second case, after deployment, the proximal portion of the stent moved into the aneurysm as the exchange guidewire was removed. This patient was treated by vessel sacrifice. Detachable coils are established as a safe and ef-fective treatment option for some patients with intra-cranial aneurysms (1). Not all patients are good can-didates for endovascular therapy. Wide-neck aneurysms are particularly challenging. Both subtotal aneurysm occlusion with coils and aneurysm recur-rence have been associated with large dome-to-neck ratios (2, 3). The balloon remodeling technique pio-neered by Moret has given endovascular therapists greater latitude in treating aneurysms with unfavor-able neck-to-dome ratios (4). Another approach has been to use a balloon expandable coronary stents to bridge the neck of wide-neck aneurysms (5). These stents are relatively stiff and are not approved for this use by the Food and Drug Administration (FDA). Recently, the self-expanding Neuroform stent (Boston Scientific/Target Therapeutics, Inc., Natick, MA) has been approved by the FDA specifically for the treatment of wide-neck aneurysms. The stent is constructed of nitinol and has diameters ranging from 2.5 mm to 4.5 mm and lengths ranging from 10 mm to 20 mm. The interstices of the deployed stent vary from 2.0F to 2.5F, allowing the placement of a micro-catheter through the stent and into the aneurysm. The radial force exerted by the stent is minimal at 10 mm Hg as compared with the Radius Stent (Bosto