Treating coil migration in combination therapy involving stenting and coiling for a wide-necked renal aneurysm
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CASE REPORT
Treating coil migration in combination therapy involving stenting and coiling for a wide-necked renal aneurysm Hirotaka Oda • Tomoyasu Suzuki • Keiichi Tsuchida Kazuyuki Ozaki • Kazuyoshi Takahashi • Tsutomu Miida
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Received: 9 February 2011 / Accepted: 27 May 2011 / Published online: 23 June 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract A man with a wide-necked renal artery aneurysm underwent combination therapy involving stenting and coiling to embolize it. However, a large section of one of the coils had migrated outside the stent implanted across the orifice of the aneurysm. After repositioning the migrated coil inside the stent, the implantation of another stent together with sandwiching of the coil between two stents repaired the prolapsed coil. This report describes precautions that should be taken during combination therapy involving stenting and coiling to embolize a widenecked aneurysm. Keywords
Renal artery Catheterization Embolization
Introduction The indications for surgical intervention to treat renal artery aneurysms remain unclear, although several reports have said that symptomatic or enlarging aneurysms, aneurysms in women of childbearing age, and aneurysms of over 2.5 cm in diameter or over 1.5 cm in cases involving hypertension, should be treated by surgical techniques or coil embolization [1–3]. Regarding the embolization of wide-necked renal artery aneurysms, it was recently reported that a combination of stenting and coiling is feasible because the implanted stent inhibits the protrusion and migration of coils [4, 5]. We report a case in which a large part of a coil moved out of a stent that had
H. Oda (&) T. Suzuki K. Tsuchida K. Ozaki K. Takahashi T. Miida Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata 950-1197, Japan e-mail: [email protected]
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been implanted across the orifice of a wide-necked renal artery aneurysm. The implantation of another stent inside the stent after the migrated part of the coil had been repositioned using a wire-helix composed of twin wires was useful.
Case report A 50-year-old male with hypertension in whom an ultrasonographic examination showed a left renal artery aneurysm visited our hospital in order to undergo a further examination of the asymptomatic renal artery aneurysm. The physical examination of the patient was unremarkable (BP 130/92 mmHg, under treatment with an antihypertensive drug), and his blood tests were normal (creatinine 1.0 mg/dl). A computed tomography revealed that the aneurysm was located in the main left renal artery, that it was 20 9 20 mm in size with a wide neck, and that an anteromedial segment branch had arisen near the aneurysm. We informed the patient and his family about choices for the treatment: untreated observation, surgical intervention, and catheter intervention. The patient also hoped to undergo coil embolization of the aneurysm.
Procedure An angiography of his left renal artery via the right f
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