Utilizing the Trans-Cell Approach as a Salvage Treatment for an Unopened Flow Redirection Endoluminal Device in a Flow-Related AneurysmAssociated with Arteriovenous Malformation: A Case Report

We report the first case demonstrating the viability of the trans-cell approach as a salvage strategy in situations where Flow Redirection Endoluminal Devices (FREDs) fail to open.

A 64-year-old woman was admitted to our facility after a motorcycle accident. During her examination, an arteriovenous malformation (AVM) in the right temporal lobe was incidentally discovered. The AVM was associated with large flow-related aneurysms in the bilateral supraclinoid internal carotid artery (ICA), as revealed by computed tomography and magnetic resonance imaging. The AVM was surgically removed, and the aneurysm was treated endovascularly using a FRED. However, the middle section of the FRED failed to open post-deployment. We successfully carried out a salvage therapy using the stent strut technique with a Headway Duo microcatheter for coiling.

The trans-cell technique utilizing aHeadwayDuo156 microcatheter can beaneffective salvage treatment forunopened FRED stents used in brain aneurysm cases.