J Cerebrovasc Endovasc Neurosurg.  2016 Mar;18(1):48-54. 10.7461/jcen.2016.18.1.48.

Retrieval of Distally Migrated Coils with Detachable Intracranial Stent during Coil Embolization of Cerebral Aneurysm

• Singh DP
• Kwon SC
• Huang L
• Lee WJ

• KMID: 2161703
• DOI: http://doi.org/10.7461/jcen.2016.18.1.48

Abstract

Migration of coils during endovascular procedures is a rare, but well-known complication. We are reporting two cases of successfully retrieving migrated coil using detachable intracranial stent. In both of our cases there was distal migration of coil during the intracranial aneurysm coiling procedure. The Solitaire® AB stent (Covidien, Irvine, CA, USA) was used to retrieve those coils. The stent was passed distal to the migrated coil using standard technique. It was then partially deployed and gradually withdrawn along with the entangled coil. Coil retrieval using the fully retrievable intracranial stent is a very simple, safe and easily available alternative for retrieval of distally migrated coil.

Keyword

Endovascular procedure; Complication; Intracranial aneurysm; Stent

MeSH Terms

Embolization, Therapeutic*
Endovascular Procedures
Intracranial Aneurysm*
Stents*

Figure

• 

  Fig. 1 One year, follow-up 3-dimensional cerebral angiography (showed trifurcation of A2 and residual aneurysmal sac of A-com aneurysm).

• 

  Fig. 2 Intra-operative angiography. A stent was placed around aneurysmal neck and further coil was placed in aneurysmal sac.

• 

  Fig. 3 Angiography showing the migrated filling coils to the proximal anterior cerebral artery.

• 

  Fig. 4 Cerebral angiography (A) and micro-angiography (B, C) showing further migration of coil into distal anterior cerebral artery.

• 

  Fig. 5 Micro-angiography (A, B) showing distally navigated microcatheter beyond migrated coil.

• 

  Fig. 6 Roadmap images (A, B) showing deployed stent with entangled coil.

• 

  Fig. 7 Photograph showing the removed Solitaire stent with the coil.

• 

  Fig. 8 Initial cerebral angiography showing a right P-com. aneurysm.

• 

  Fig. 9 Angiography showing the migrated filling coils to the middle cerebral artery (arrow).

• 

  Fig. 10 Roadmap images (A, B) showing distally navigated microcatheter beyond migrated coil and deployed stent with coil.

• 

  Fig. 11 The final angiogram showing totally occluded aneurysm and with well-preserved distal middle cerebral artery flows.

Reference

1. Cekirge S, Saatci I, Firat MM, Balkanci F. Retrieval of an embolization coil from the internal carotid artery using the Amplatz microsnare retrieval system. Cardiovasc Intervent Radiol. 1995; Jul-Aug. 18(4):262–264. PMID: 8581910.

2. 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. discussion E210. PMID: 15987594.

3. Graves VB, Rappe AH, Smith TP, Sepetka I, Ahuja A, Strother CM. An endovascular retrieving device for use in small vessels. AJNR Am J Neuroradiol. 1993; Jul-Aug. 14(4):804–808. PMID: 8352148.

4. 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; 2. 27(2):327–329. PMID: 16484403.

5. Hopf-Jensen S, Hensler HM, Preiß M, Müller-Hülsbeck S. Solitaire® stent for endovascular coil retrieval. J Clin Neurosci. 2013; 6. 20(6):884–886. PMID: 23623613.

6. Koseoglu K, Parildar M, Oran I, Memis A. Retrieval of intravascular foreign bodies with goose neck snare. Eur J Radiol. 2004; 3. 49(3):281–285. PMID: 14962660.

7. Lee CY. Use of wire as a snare for endovascular retrieval of displaced or stretched coils: rescue from a technical complication. Neuroradiology. 2011; 1. 53(1):31–35. PMID: 20352417.

8. Liu KC, Ding D, Starke RM, Geraghty SR, Jensen ME. Intraprocedural retrieval of migrated coils during endovascular aneurysm treatment with the Trevo Stentriever device. J Clin Neurosci. 2014; 3. 21(3):503–506. PMID: 24332812.

9. O'Hare AM, Rogopoulos AM, Stracke PC, Chapot RG. Retrieval of displaced coil using a Solitaire(®) stent. Clin Neuroradiol. 2010; 12. 20(4):251–254. PMID: 20967402.

10. Oh J, Kim J, Hong S, Hu C, Pyen J, Whang K, et al. Retrieval of unintended migrated detached coil: case report. J Cerebrovasc Endovasc Neurosurg. 2014; 9. 16(3):268–274. PMID: 25340030.

11. Prestigiacomo CJ, Fidlow K, Pile-Spellman J. Retrieval of a fractured Guglielmi detachable coil with use of the Goose Neck snare "twist" technique. J Vasc Interv Radiol. 1999; 10. 10(9):1243–1247. PMID: 10527203.

12. Raftopoulos C, Goffette P, Billa RF, Mathurin P. Transvascular coil hooking procedure to retrieve an unraveled Guglielmi detachable coil: technical note. Neurosurgery. 2002; 4. 50(4):912–914. discussion 914-5PMID: 11904050.

13. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira R, et al. SOLITAIRETM with the intention for thrombectomy (SWIFT) trial: design of a randomized, controlled, multicenter study comparing the SOLITAIRE™ Flow Restoration device and the MERCI Retriever in acute ischaemic stroke. Int J Stroke. 2014; 7. 9(5):658–668. PMID: 23130938.

14. Schütz A, Solymosi L, Vince GH, Bendszus M. Proximal stent fixation of fractured coils: technical note. Neuroradiology. 2005; 11. 47(11):874–878. PMID: 16142481.

15. 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; 5. 7(3):259–262. PMID: 10833627.

16. Smith TP, Graves VB, Halbach VV, Higashida RT, Fraser KW, Dowd CF, et al. Microcatheter retrieval device for intravascular foreign body removal. AJNR Am J Neuroradiol. 1993; Jul-Aug. 14(4):809–811. PMID: 8352149.

17. 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; 11. 35(5):994–998. discussion 999PMID: 7838356.

18. Thornton J, Dovey Z, Alazzaz A, Misra M, Aletich VA, Debrun GM, et al. Surgery following endovascular coiling of intracranial aneurysms. Surg Neurol. 2000; 11. 54(5):352–360. PMID: 11165609.

19. 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; 1. 18(1):81–84. PMID: 18190501.

20. Watanabe A, Hirano K, Mizukawa K, Kamada M, Okamura H, Suzuki Y, et al. Retrieval of a migrated detachable coil--case report. Neurol Med Chir (Tokyo). 995; 4. 35(4):247–250. PMID: 7596469.

21. Zoarski GH, Bear HM, Clouston JC, Ragheb J. Endovascular extraction of malpositioned fibered platinum microcoils from the aneurysm sac during endovascular therapy. AJNR Am J Neuroradiol. 1997; 4. 18(4):691–695. PMID: 9127031.