J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):287-292. 10.7461/jcen.2014.16.3.287.

Surgical Recanalization of Distal Middle Cerebral Artery Occlusion Due to a Coil Migration During Endovascular Coil Embolization: A Case Report

• Kim HS
• Lee JM
• Koh EJ
• Choi HY

• KMID: 1963169
• DOI: http://doi.org/10.7461/jcen.2014.16.3.287

Abstract

Coil migration into the parent artery during endovascular coil embolization is a rare, but life-threatening complication, which can induce thromboembolism and result in poor outcome. A 63-year-old man was referred to Chonbuk National University Hospital emergency center due to migration of a coil for a left middle cerebral artery bifurcation unruptured aneurysm. We performed an emergency craniectomy to remove the coil migrated to the distal M2 branch and thrombus, and aneurysmal neck clipping for his aneurysm. Fortunately, at the six month follow-up, the patient did not show any noticeable neurological sequela. In case of parent artery occlusion due to coil migration an immediate recanalization should be performed by a neurovascular specialist who can provide both surgical treatment and endovascular management in order to prevent severe sequela or even death.

Keyword

Endovascular coil embolization; Cerebrovascular complication; Neurosurgical procedure

MeSH Terms

Aneurysm
Arteries
Embolization, Therapeutic*
Emergencies
Follow-Up Studies
Humans
Infarction, Middle Cerebral Artery*
Jeollabuk-do
Middle Aged
Middle Cerebral Artery
Neck
Neurosurgical Procedures
Parents
Specialization
Thromboembolism
Thrombosis

Figure

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  Fig. 1 The initial computed tomography scan showing a metallic object which appears to be a migrated coil around the left insula (black arrow).

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  Fig. 2 (A, B) Cerebral angiography showing a saccular aneurysmal sac, which measured 9.41 mm × 6.54 mm in size with a relatively broad neck of 4.38 mm at the left middle cerebral artery bifurcation.

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  Fig. 3 (A, B) Cerebral angiography shows that the coil part of coil embolization has detached from the aneurysmal sac and migrated to the left M2 inferior branch (black arrow).

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  Fig. 4 (A, B) Intraoperative field image showing a migrated coil and thrombus in the distal middle cerebral artery, and arteriotomy after removal of coil and thrombus.

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  Fig. 5 Postoperative computed tomography shows the aneurysmal sac, which was clipped using a clip, and the presence of bony defect because of a prophylactic decompressive craniectomy (black arrow).

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  Fig. 6 (A) Postoperative magnetic resonance diffusion-weighted imaging presenting the acute cerebral infarction in the left M2 inferior division territory. (B) Magnetic resonance angiography demonstrating decreased blood flow in the left M1 distal portion maybe due to a clip artifact (white arrow).

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