Bailout stentectomy of 47 self-expandable intracranial stents

Abstract

BackgroundSelf-expanding stents are increasingly being deployed for stent-assisted coiling or flow diversion of intracranial aneurysms. Complications related to stent misbehavior may arise, however, including lack of expansion, device displacement, or parent vessel thrombosis. We present our experience of various stent removal techniques (stentectomy) with a focus on technical and clinical outcomes.MethodsStentectomy was attempted either with a single device, including the Alligator, Microsnare, or Solitaire, or by combining a Microsnare with a second device. Dual techniques included in this report are the Snare-over-Stentretriever technique we developed using a Microsnare and a Solitaire, and the previously described Loop-and-Snare technique using a Microsnare and a microwire. The technical success and complication rate, as well as the clinical outcome using the mRS were analyzed.ResultsForty-seven stentectomies were attempted in 36 patients treated for 37 aneurysms. Forty-two devices (89.3%) were successfully retrieved. Single-device stentectomy was successful in 34% of cases, compared with 74% with dual-device techniques. Of the 20 patients with a thrombosed parent or efferent vessel, 17 were successfully recanalized using stentectomy. All successful stentectomy patients made a clinically uneventful recovery, except one with a minor postoperative stroke (mRS 1 at discharge). Failed stentectomy was associated with major ischemic stroke in two patients and death in one patient. There were no stentectomy-related vessel perforations or dissections.ConclusionWhile various single devices can be used to safely retrieve dysfunctional intracranial self-expandable stents, dual-device techniques are more than twice as effective, according to our experience.