J Cerebrovasc Endovasc Neurosurg.  2023 Jun;25(2):196-202. 10.7461/jcen.2022.E2022.04.001.

Migrated coil and damaged stent removal during coil embolization, using an additional, retrievable stent: A case report

• Noh HS
• Park SC
• Lee JM
• Kwon SC

• KMID: 2543516
• DOI: http://doi.org/10.7461/jcen.2022.E2022.04.001

Abstract

One of the common complications that can occur during coil embolization of cerebral aneurysms, is migration of coil lump alone. The removal of these migrated coils has been reported on a few occasions. On the other hand, rare complications would include the migration of the coil with subsequent stent dislocation. Currently, there is no standardized method to correct the complications of stent dislocation, and very few instances of this complication have been reported previously. In this report, we introduce a case of coil migration combined with stent dislocation. This occurred during coil embolization of an unruptured aneurysm of the distal, left internal carotid artery for a 52-year old woman. We retrieved both the damaged stent and migrated coil using another retrievable stent successfully with no more further complications. In the present report, we describe in detail how we corrected the complication successfully stent, and we discuss why this rescue maneuver is reasonable option for the complication mentioned above.

Keyword

Intracranial aneurysm; Endovascular procedures; Stents; Intraoperative complications

Figure

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  Fig. 1. Frontal (A) and lateral (B) angiogram showing that initial coil embolization was successfully completed by stent application and jailing technique.

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  Fig. 2. Frontal (A) and lateral (B) road map view showing the migrated coil to M1 (black arrow) and the proximal end (white arrow) and distal end (red arrow) of dislocated stent in the proximal portion of the ICA. ICA, internal carotid artery

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  Fig. 3. During the retrieval, another microcatheter (black arrow) was placed on the distal portion of the migrated coil (A), and the migrated coil lump (white arrow) was retrieved (B) using another stent.

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  Fig. 4. After coil embolization, another attempt to retrieve the damaged stent was made (A). The damaged stent (black arrow) was captured using another stent (white arrow) (B) and retrieved successfully.

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  Fig. 5. Final angiogram of left ICA showing intact blood flow and no further complications, such as dissection or extravasation, were noted. ICA, internal carotid artery

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  Fig. 6. Schematic approach supporting comprehension of the reason why a deployed stent was damaged and migrated. One anchor of the stent was potentially stuck in the catheter, the stent migrated when pulling the catheter (arrow) (A), and coil migration followed as neck of the aneurysm was uncovered (arrow) (B).

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