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

• Stidd DA
• Johnson AK
• Lopes DK

• KMID: 1910770
• DOI: http://doi.org/10.5469/neuroint.2014.9.1.21

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.

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  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.

Reference

1. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg. 2003; 98:959–966. PMID: 12744354.

2. Cognard C, Weill A, Castaings L, Rey A, Moret J. Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology. 1998; 206:499–510. PMID: 9457205.

3. Derdeyn CP, Cross DT 3rd, Moran CJ, Brown GW, Pilgram TK, Diringer MN, et al. Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg. 2002; 96:837–843. PMID: 12008697.

4. Eddleman CS, Welch BG, Vance AZ, Rickert KL, White JA, Pride GL, et al. Endovascular coils: properties, technical complications and salvage techniques. J Neurointerv Surg. 2013; 5:104–109. PMID: 22345145.

5. Chung J, Kim YB, Hong CK, Joo JY, Shin YS, Lim YC. Stent salvage using the Enterprise stent for procedure-related complication during coil embolization of ruptured intracranial aneurysms. Acta Neurochir (Wien). 2013; 155:223–229. PMID: 23149588.

6. Luo CB, Chang FC, Teng MM, Guo WY, Chang CY. Stent management of coil herniation in embolization of internal carotid aneurysms. AJNR Am J Neuroradiol. 2008; 29:1951–1955. PMID: 18719031.

7. Schutz A, Solymosi L, Vince GH, Bendszus M. Proximal stent fixation of fractured coils: technical note. Neuroradiology. 2005; 47:874–878. PMID: 16142481.

8. Wong GKC, Yu SCH, Wong KT, Poon WS. Stent salvage for parent vessel coil herniation during intracranial aneurysm embolization. Surg Pract. 2009; 13:114–118.

9. Sugiu K, Martin JB, Jean B, Rufenacht DA. Rescue balloon procedure for an emergency situation during coil embolization for cerebral aneurysms. Technical note. J Neurosurg. 2002; 96:373–376. PMID: 11838815.

10. Lampmann LE, Sluzewski M, Van Rooij WJ. Retrieval of malpositioned, dislocated or fractured guglielmi detachable coils from intracranial vessels. A report of seven cases. Interv Neuroradiol. 2000; 6:251–256. PMID: 20667204.

11. Koseoglu K, Parildar M, Oran I, Memis A. Retrieval of intravascular foreign bodies with goose neck snare. Eur J Radiol. 2004; 49:281–285. PMID: 14962660.

12. Henkes H, Lowens S, Preiss H, Reinartz J, Miloslavski E, Kuhne D. A new device for endovascular coil retrieval from intracranial vessels: alligator retrieval device. AJNR Am J Neuroradiol. 2006; 27:327–329. PMID: 16484403.

13. Dinc H, Kuzeyli K, Kosucu P, Sari A, Cekirge S. Retrieval of prolapsed coils during endovascular treatment of cerebral aneurysms. Neuroradiology. 2006; 48:269–272. PMID: 16534608.

14. Kung DK, Abel TJ, Madhavan KH, Dalyai RT, Dlouhy BJ, Liu W, et al. Treatment of endovascular coil and stent migration using the merci retriever: report of three cases. Case Rep Med. 2012; 2012:242101. PMID: 22666264.

15. O'Hare A, Brennan P, Thornton J. Retrieval of a Migrated Coil Using an X6 MERCI Device. Interv Neuroradiol. 2009; 15:99–102. PMID: 20465937.

16. Vora N, Thomas A, Germanwala A, Jovin T, Horowitz M. Retrieval of a displaced detachable coil and intracranial stent with an L5 Merci Retriever during endovascular embolization of an intracranial aneurysm. J Neuroimaging. 2008; 18:81–84. PMID: 18190501.

17. Hopf-Jensen S, Hensler HM, Preiss M, Muller-Hulsbeck S. Solitaire(R) stent for endovascular coil retrieval. J Clin Neurosci. 2013; 20:884–886. PMID: 23623613.

18. Leslie-Mazwi TM, Heddier M, Nordmeyer H, Stauder M, Velasco A, Mosimann PJ, et al. Stent retriever use for retrieval of displaced microcoils: a consecutive case series. AJNR Am J Neuroradiol. 2013; 34:1996–1999. PMID: 23764724.

19. Heuer GG, Zaghloul KA, Roberts R, Stiefel MF, Storm PB. Successful microsurgical extraction of a migrated coil in a pediatric patient after failed endovascular closure of a Blalock-Taussig shunt. Case report. J Neurosurg. 2007; 106(2 Suppl):136–138. PMID: 17330541.

20. Kojima T, Miyachi S, Negoro M, Nakabayashi K, Fukui K, Takahashi I, et al. Coil retrieval following embolization of cerebral aneurysms. Interv Neuroradiol. 2003; 9(Suppl 1):149–155. PMID: 20591245.

21. Raftopoulos C, Goffette P, Billa RF, Mathurin P. Transvascular coil hooking procedure to retrieve an unraveled Guglielmi detachable coil: technical note. Neurosurgery. 2002; 50:912–914. PMID: 11904050.

22. Shin YS, Lee KC, Kim DI, Lee KS, Huh SK. Emergency surgical recanalisation of A1 segment occluded by a Guglielmi detachable coil. J Clin Neurosci. 2000; 7:259–262. PMID: 10833627.

23. Thornton J, Dovey Z, Alazzaz A, Misra M, Aletich VA, Debrun GM, et al. Surgery following endovascular coiling of intracranial aneurysms. Surg Neurol. 2000; 54:352–360. PMID: 11165609.

24. Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG. Monorail snare technique for the recovery of stretched platinum coils: technical case report. Neurosurgery. 2005; 57(1 Suppl):E210. PMID: 15987594.

25. Standard SC, Chavis TD, Wakhloo AK, Ahuja A, Guterman LR, Hopkins LN. Retrieval of a Guglielmi detachable coil after unraveling and fracture: case report and experimental results. Neurosurgery. 1994; 35:994–998. PMID: 7838356.

26. Ng PP, Halbach VV, Caragine LP, Dowd CF, Higashida RT. Guglielmi detachable coil extraction: suction generated by pusher-wire withdrawal after coil detachment within an intracranial aneurysm. AJNR Am J Neuroradiol. 2003; 24:982–984. PMID: 12748107.