Surgical management of a paraclinoid aneurysm containing a displaced neuroform microstent: technical case report.

OBJECTIVE: We report the first case of clip obliteration of a cerebral aneurysm containing a displaced microstent.

CLINICAL PRESENTATION: A 63-year-old woman presented with a 6-month history of headaches. She had no other neurological symptoms, and her examination was normal. A computed tomographic scan showed no evidence of hemorrhage. Angiography confirmed the presence of a large left paraclinoid aneurysm.

INTERVENTION: The patient initially underwent attempted endovascular repair of the aneurysm. A Neuroform microstent (Boston Scientific, Natick, MA), which was placed across the aneurysm neck, migrated into the aneurysm upon passing through it with the microcatheter to be used to place coils. This left the proximal half of the stent in the aneurysm and the distal half in the internal carotid artery. Attempts to remove the stent and to place a second stent across the neck of the aneurysm failed, and any plans to place coils were aborted. Three months after the failed endovascular procedure, the patient consented to a craniotomy. The aneurysm was successfully obliterated by placing several clips directly across the neck of the aneurysm and leaving the stent in place.

CONCLUSION: The patient experienced an excellent clinical and angiographic outcome. Although not the ideal treatment strategy, this report illustrates that clip obliteration of aneurysms containing displaced microstents can be performed successfully for this complication of endovascular treatment.