E-164 Novel use for everflex self-expanding biliary stent after irretrievable accunet embolic protection device in the vertebral artery

Introduction Vertebral artery (VA) stenosis can lead to recurrent posterior circulation transient ischemic attacks and strokes. Stenting is often used for symptomatic VA stenosis. As with carotid stenting, embolic protection devices (EPD) are increasingly used when stenting the proximal VA. EPDs can become lost in the circulation during stenting for different reasons. We report the only known case and treatment strategy for an irretrievable EPD during VA stenting. Methods Since there are no known reported cases of an irretrievable EPD in the VA, a systematic review of the medical literature was performed to search for irretrievable EPDs in the carotid artery. The bibliographies of each result were used to identify additional publications until this process was exhausted. Results A total of four cases were found where an EPD was lost in the carotid circulation. In two of the cases, a carotid arteriotomy was required to retrieve the EPD, while the other two cases used an endovascular approach. In our VA case, an endovascular EverFlex Biliary Stent was used to flatten and permanently implant the irretrievable EPD against the VA wall. Conclusions In all cases, complications in retrieving the EPD resulted from the inability to withdraw the EPD through the deployed stent. Nearby acutely branching vessels, severe vascular stenosis, and vessel angulation at the stent margin were shown to impair the ability to retrieve the EPD at the end of the case. In conclusion, compressing a lost VA EPD using an oversized self-expanding stent can successfully restore robust blood flow, especially in areas not readily accessible to open surgical techniques. Disclosures J. Soto: None. K. Lyon: None. W. Lesley: None.