The stent was patent. Additionally, partial stent deployment has been used to removed herniated coils [23]. The triaxial assembly consisted of a 9 Fr Cello™ (ev3) for BGC, the Arc™ catheter (Medtronic) as the intracranial AC, and the Excelsior® XT-27® microcatheter (Stryker Neurovascular), which was, in turn, navigated over a Synchro-2® microwire (Stryker Neurovascular) into … Featuring Synchro Guidewire technology designed to enhance torque transmission through its microfabricated outer structure. The patient had an uneventful postoperative course and was discharged to home neurologically intact. A Prowler Select Plus microcatheter (Cordis Endovascular, Miami Lakes, Florida, USA) led by a Synchro 2 soft microwire (Boston Scientific, Natick, MA, USA) was advanced into the distal ICA. To navigate across these aneurysms, a 0.014-inch microwire is used, which often does not offer a sturdy enough rail to advance a 0.027-inch microcatheter past dissecting artery aneurysm ostia. The aneurysm was then embolized using two HydroFrame coils (MicroVention, Aliso Viejo, CA, USA) through an Excelsior SL 10 microcatheter (Boston Scientific, Natick, MA, USA) positioned within the aneurysm dome (Figures 1(a) and 1(b)). The Merci Retriever, the 18 L Merci microcatheter, and the 6 F guiding catheter were then removed. [14] reported the case of a 37-year-old man who suffered a subarachnoid hemorrhage from vertebral confluence aneurysm. Our experience demonstrates that the Merci device can be used successfully to rescue patients with this potentially devastating complication. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Department of Neurosurgery, Gates Vascular Institute at Kaleida Health. Comparative analysis of the Pipeline and the Derivo flowdiverters for the treatment of unruptured intracranial aneurysms - a multicentric study. At this point the SSEP signals returned to normal. The risk of coil migration is influenced by anatomical, flow, and technical factors. Chief of ID, VA Ann Arbor Healthcare System, Full or Associate Professor, Head of the Division of Geriatrics, Copyright © 2020 Congress of Neurological Surgeons. Occlusion of cerebral aneurysms by detachable coils through the endovascular approach has gained significant popularity over the last two decades and is now a common approach for securing cerebral aneurysms [1–3]. ), Update your browser to view this website correctly. It is likely that there have been other cases of unsuccessful use of the Merci Retriever that have not been reported, and more research is necessary to determine the role the Merci Retriever will play in the treatment of coil migration complications. See package insert for complete indications, complications, warnings, and instructions for use. Stent deployment has been utilized as a means of trapping migrated coils into the aneurysm sac or against the vessel wall with promising results [15, 22]. Unfortunately the patient’s clinical exam did not improve significantly, and the family decided on palliative care. Attempts to engage the stent and coils using the Synchro 2 soft … A number of techniques have been derived, but none have gained acceptance as a gold standard [6]. With the widespread use of endovascular treatment for aneurysms comes the new consideration of retrieving dislodged foreign bodies intravascularly. On three-month followup the patient remains neurologically normal (modified Rankin score = 0); and she has 20/20 vision bilaterally. Migration of the stent was noted during deployment, but it still covered the neck of the aneurysm.

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