Endovascular retrieval of a prematurely deployed covered stent

Abstract

Several techniques have been reported to address different endovascular device failures. We report the case of a premature deployment of a covered balloon mounted stent during endovascular repair of a post-traumatic carotid-cavernous fistula (CCF). A 50-year-old male suffered a fall resulting in loss of consciousness and multiple facial fractures. Five weeks later, he developed decreased left visual acuity, proptosis, chemosis, limited eye movements and cranial/orbit bruit. Cerebral angiography demonstrated a direct left CCF and endovascular repair with a 5.0 mm × 19 mm covered stent was planned. Once in the lacerum segment, increased resistance was encountered and the stent was withdrawn resulting in premature deployment. A 3 mm × 9 mm balloon was advanced over an exchange length microwire and through the stent lumen. Once distal to the stent, the balloon was inflated and slowly pulled back in contact with the stent. All devices were successfully withdrawn as a unit. The use of a balloon to retrieve a prematurely deployed balloon mounted stent is a potential rescue option if leaving the stent in situ carries risks.

Keywords: Stent retrieval, Covered stent, Premature stent deployment

Core tip: Increasingly complex neurovascular lesions are now amenable to endovascular therapy due to the development of new devices and techniques. However, malfunction or failure of these devices remains a potential hurdle to a successful treatment. Consequently, a growing body of reports describing rescue and salvage techniques have emerged. In this report, we discuss the endovascular retrieval of a prematurely deployed covered stent during the treatment of a traumatic carotid-cavernous fistula.