J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):268-274. 10.7461/jcen.2014.16.3.268.

Retrieval of Unintended Migrated Detached Coil: Case Report

• Oh J
• Kim J
• Hong S
• Hu C
• Pyen J
• Whang K
• Cho S
• You DS

• KMID: 1963166
• DOI: http://doi.org/10.7461/jcen.2014.16.3.268

Abstract

Owing to the rapid development of intervention techniques and devices, endovascular coil embolization of cerebral arteries has become standardized. It is particularly preferred when a patient presents with an unruptured intracranial aneurysm of the posterior communicating artery (PcomA). However, the risk of thrombogenic complications of the coil migration may also result in a large cerebral infarction. When coil migration occurs during embolization, a procedure for removal of the embolic coil should be performed immediately. We experienced a clinically rare case of migration of a framing coil to the distal middle cerebral artery aneurysm during endovascular embolization of an unruptured PcomA aneurysm. The migrated coil was barely retrieved using snare techniques.

Keyword

Aneurysm; Coil distal migration; Coil retrieval; Frame

MeSH Terms

Aneurysm
Arteries
Cerebral Arteries
Cerebral Infarction
Embolization, Therapeutic
Humans
Intracranial Aneurysm
SNARE Proteins
SNARE Proteins

Figure

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  Fig. 1 Pre-operative transfemoral cerebral angiography (TFCA). TFCA shows a right posterior communicating artery aneurysm.

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  Fig. 2 Roadmap images of the intra-operative angiography. (A, B) A microcatheter is located in the posterior communicating artery aneurysm, and two coils are inserted in the aneurysmal sac. (C) At the time of the third coil insertion, a coil loop protrudes towards the parent vessel. (D) The initially detached coil has migrated to the middle cerebral artery.

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  Fig. 3 The process of retrieving the migrated coil. (A, B, C) A Goose Neck Snare® (black arrow) is introduced for retrieval of the migrated coil, but the coil has further migrated to the distal middle cerebral artery from the proximal middle cerebral artery. (D) At the end, the coil is captured by the snare retriever and removed.

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