Endovascular Retrieval of Dislodged Neurovascular Devices with a Stentriever: Case Series and Technical Review.

Abstract

Endovascular treatment of neurovascular disorders are now wellestablished as effective and safe, however, the nature of the intracranial vasculature poses unique challenges. The unintentional dislodgement or fracture of a device and its migration within cerebral vessels is a complication with serious potential morbidity which must be managed urgently. In this series the authors describe seven cases of a stentriever being used to remove foreign objects from within the cerebral vasculature CASES: Five dislodged endovascular coils, one microcatheter and one fractured stentriever were technically successfully retrieved. In six of the cases the foreign object was successfully removed with a stentriever alone, while one case utilised a J-tip wire and a "J-tip flick" to manipulate the coil and facilitate retrieval. Stentrievers, particularly when used alone, confer the advantages of speed, cost as well as being tailor-made for cerebral vessels. They also allow continuous blood flow when deployed, a critical advantage when considering cerebral perfusion. Critical techniques including the gradual deployment of the stentriever alongside the foreign object to allow their entanglement and partial resheathing, so that the foreign object can become pinned within the microcatheter. Stentrievers do remain limited by vessel calibre and are less able to entangle larger, stiffer devices. The migration of foreign devices during neurointerventional procedures is a serious complication requiring urgent treatment. This case series highlights the efficacy and advantages of using a stentriever and suggests its consideration as a first-line technique in recovering dislodged foreign bodies in the cerebral vasculature.