Disruption and migration of an Enterprise VRD delivery wire during coil embolization for unruptured cerebral aneurysm: case report

Abstract

Objective: We report a case of disruption and migration of the distal portion of the delivery wire from an Enterprise Vascular Reconstruction Device (VRD) during coil embolization for an unruptured cerebral aneurysm.
Case presentation: A 63-year-old woman, who had undergone neck clipping for an aneurysm of the right internal carotid-posterior communicating artery 12 years previously, suffered a recurrence at the same location. Stent-assisted coil embolization using an Enterprise VRD was chosen for repair because of its wide neck. After insufficient coil embolization with the initial Enterprise VRD, a second Enterprise VRD was deployed in a stent-in-stent manner. Following deployment of the second stent, a distal section of the delivery wire became disrupted and migrated distal to the aneurysm. Craniotomy was performed for direct surgical removal of the migrated wire because endovascular retrieval with a goose neck snare proved too difficult.
Conclusion: Disruption of the delivery wire from an Enterprise VRD is extremely rare but possible. Physicians should be aware of this potential problem in patients with a tortuous parent artery and proceed with caution to avoid excessive stress to the device.