Intra-Distal Access Catheter Deployment of the Surpass Evolve Device: A Novel Technique to Prevent Advancement of the Delivery Wire: A Case Report and Literature Review.

Objective: Flow diverter stent (FDS) deployment in neuroendovascular therapy carries a risk of vessel injury related to unintended distal advancement of the delivery wire, particularly in cases with distal aneurysms. Safe control of wire behavior during deployment remains challenging. We describe a deployment strategy using a distal access catheter (DAC) to mitigate this risk. Case Presentation: We report a case of a 79-year-old man with multiple intracranial aneurysms, including a symptomatic large aneurysm of the right internal carotid artery and an additional distal aneurysm at the middle cerebral artery bifurcation. A Surpass Evolve Flow Diverter (Stryker, Kalamazoo, MI, USA) was deployed in the right internal carotid artery. The device was initially deployed using the standard technique; however, the deployment strategy was subsequently changed to release the device within the DAC, followed by gradual unsheathing of the catheter, to mitigate the risk of distal advancement of the delivery wire. The FDS was successfully deployed without distal wire migration or vessel injury. The postoperative course was uneventful, with no procedure-related complications. Conclusion: This case highlights a practical rescue strategy for situations in which distal wire control during FDS deployment is particularly important. Deploying an FDS within a DAC and releasing it by unsheathing may help mitigate the risk of uncontrolled distal wire advancement and enhance procedural safety in carefully selected complex cases with distal aneurysms.