Neurointervention.  2014 Feb;9(1):21-25. 10.5469/neuroint.2014.9.1.21.

Manual Aspiration Technique to Retrieve a Prematurely Detached Coil during Cerebral Aneurysm Embolization

Affiliations
  • 1Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA. brainaneurysm@mac.com

Abstract

Coil herniation, premature deployment, and fracture are procedure associated complications of endovascular aneurysm embolization that optimally necessitate coil retrieval when feasible. Several published techniques describe different strategies for managing coil complications including various snare retrieval devices, alligator retrieval devices, stent fixation, and open surgical resection of coils when distal blood flow is compromised. We report a novel technique employed to retrieve a prematurely detached coil during an aneurysm embolization using a syringe fixed to the microcatheter to carefully aspirate a loose coil with direct fluoroscopic visualization. This technique can only be utilized in the circumstance where the proximal end of the coil remains in the microcatheter. Conventional techniques of coil retrieval and stenting are discussed and compared to the rational for using the manual aspiration technique.

Keyword

Cerebral aneuryusms; Endovascular procedures/complication; Embolization, therapeutic

MeSH Terms

Alligators and Crocodiles
Aneurysm
Embolization, Therapeutic
Intracranial Aneurysm*
SNARE Proteins
Stents
Syringes
SNARE Proteins

Figure

  • Fig. 1 Anterior-posterior (A) and lateral (B) 3D reconstruction views of a digital subtraction angiogram depicting an incidentally discovered basilar tip aneurysm.

  • Fig. 2 A. Anterior-posterior fluoroscopic view of the basilar tip aneurysm filled with a coil mass. B-D. Sequential fluoroscopy frames showing release of the detached, partially deployed coil from the coil mass during aspiration through the PX400 microcatheter. The white arrows identify the distal end of the loose coil.

  • Fig. 3 Syringe connected to the PX400 microcatheter depicting the prematurely detached coil within the catheter hub after aspiration retrieval.


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