Herniated Proximal Marker of the Stent into the Meningohypophyseal Trunk after Stent-Assisted Coil Embolization for Intracranial Aneurysms

The Solitaire(TM) AB Neurovascular Remodeling Device (ev3, Irvine, CA, USA) is used to retain coils within an aneurysm, reducing the risk of embolic complications from coil herniation into the parent artery. Stents are deployed after confirming the optimal position of the stent markers across the aneurysm to avoid entry into perforators or branching arteries. Stent marker position is very important to prevent perforating or branching artery infarction. We performed stent-assisted coil embolization using the Solitaire AB stent to treat 2 aneurysms simultaneously. After successful coil embolization, we detached the Solitaire stent in the usual manner. However, the proximal stent marker, which was located at the horizontal segment of the cavernous internal carotid artery, moved into the meningohypophyseal trunk and occluded it. Although the distal markers were positioned optimally, we did not expect the proximal marker to be in the position where it was located. Fortunately, cranial nerve dysfunctions and pituitary deficiency did not develop. It is important to prevent ischemic injury by occlusion of the perforators or branching vessels that can be caused by malpositioned stent markers. We consider where the proximal marker of the stent might be located after detachment.