J Korean Neurosurg Soc.  2014 Oct;56(4):364-367. 10.3340/jkns.2014.56.4.364.

Endovascular Rescue Method for Undesirably Stretched Coil

• Cho JH

• KMID: 2018092
• DOI: http://doi.org/10.3340/jkns.2014.56.4.364

Abstract

Undesirable detachment or stretching of coils within the parent artery during aneurysm embolization can be related with thrombus formation, which can be caused occlusion of parent artery or embolic event(s). To escape from this situation, several rescue methods have been reported. A case with undesirably stretched coil in which another rescue method was used, is presented. When the stretched coil is still located in the coil delivery microcatheter, the stretched coil can be removed safely using a snare and a handmade monorail microcatheter. After a snare is lodged in the handmade monorail microcatheter, the snare is introduced over the coil delivery micorcatheter and located in the distal part of the stretched coil. After then, the handmade monorail microcatheter captures the stretched coil and the snare as one unit. This technique using a handmade monorail microcatheter and a snare can be a good rescue modality for the undesirably stretched coil, still remained within the coil delivery microcatheter.

Keyword

Intracranial aneurysm; Embolization; Complication; Removal

MeSH Terms

Aneurysm
Arteries
Humans
Intracranial Aneurysm
Parents
SNARE Proteins
Thrombosis
United Nations
SNARE Proteins

Figure

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  Fig. 1 Left internal carotid angiography shows a paraclinoid aneurysm.

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  Fig. 2 A : Intraoperative angiography (anterior-posterior projection) demonstrates stretching of the coil. The white arrow indicates the proximal marker of coil pusher wire. B : Angiography (lateral projection) reveals that proximal portion of the stretched coil is still remained within the coil delivery catheter.

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  Fig. 3 A : Photograph showing the handmade monorail Prowler Select Plus microcatheter bearing the snare wire. An arrow indicates a side hole, near 2 cm from the distal end such as a monorail microcatheter. B : Photograph showing the external environment. Note the application of a mosquito forceps to fix the coil delivery catheter (cut) (arrow) for the prevention of shifting of the catheter and the coil. A double arrow indicates the proximal part of the snare and an open arrow indicates the monorailed Prowler Select Plus microcatheter.

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  Fig. 4 Angiography (lateral projection) demonstrates that the location of the snare is located in the distal part of the stretched coil.

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  Fig. 5 The handmade monorail microcatheter captures the stretched coil and the snare as one unit.

Reference

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