Acute Distal Migration and Shortening of the Flow-Redirection Endoluminal Device: A Case Report

Objective: The flow diverter (FD) is a promising device. Apart from two main complications, hemorrhagic and ischemic ones, stent migration is reportedly an unusual complication. In particular, distal migration of the FD has rarely been reported. We report a case of asymptomatic acute distal migration of the flow-redirection endoluminal device (FRED).

Case presentation: A 50-year-old woman was incidentally diagnosed with an unruptured right internal carotid-ophthalmic artery aneurysm with a maximum diameter of 8.0 mm, and she subsequently underwent endovascular treatment with FRED. Based on the vessel diameter (3.8 mm proximal and 3.6 mm distal to the aneurysm), a 4.0-mm-diameter and 18-mm-long FRED was deployed without postoperative complications. However, on MRA 12 months after treatment, the aneurysm was not occluded; angiography showed distal migration of the FRED. The postoperative MRA and skull X-ray images were retrospectively reviewed to determine the period of the migration. The skull X-ray images and the signal loss area due to the FRED on MRA 1 day after the treatment had already demonstrated the migration of the FRED. In the second treatment, a 4.0-mm-diameter and 23-mm-long FRED was deployed in an overlapping fashion up to the proximal part of the carotid siphon. Prompt identification of distal migration of the FD without neurologic signs could be challenging.

Conclusion: It is important to follow up meticulously with MRA and skull X-ray images after FD treatment for detecting stent migrations as early as possible.