Krishna Amuluru1, Fawaz Al-Mufti2, Charles E Romero3. 1. Department of Interventional Neuroradiology, University of Pittsburgh Medical Center-Hamot, Erie, Pennsylvania, USA. Electronic address: amuluruk@upmc.edu. 2. Department of Neuroendovascular Surgery and Neurocritical Care, Westchester Medical Center at New York Medical College, Valhalla, New York, USA. 3. Department of Interventional Neuroradiology, University of Pittsburgh Medical Center-Hamot, Erie, Pennsylvania, USA.
Abstract
BACKGROUND: Displacement of endovascular coils during endovascular embolization of an intracranial aneurysm is a potentially life-threatening complication. Several methods for coil retrieval have been described, including the use of microsnares and microforceps retrieval devices. With the recent surge of stentriever implementation in the treatment of ischemic stroke, some operators are now using such devices in the retrieval of migrated coils. We present a case of a balloon-assisted coil embolization of a communicating segment internal carotid artery aneurysm, complicated by coil migration far distally into the middle cerebral artery, which was retrieved successfully with a stentriever. To the best of our knowledge, this is the furthest migration of a coil to be successfully retrieved with a stentriever. We review conservative and invasive management of displaced coils and the technical advantages of stentrievers over retrieval devices. METHODS: The patient's medical records were retrospectively reviewed, including clinical and radiographic information. This study received institutional review board approval. RESULTS: The patient was treated with balloon-assisted coil embolization of the internal carotid artery aneurysm. The migrated coil was retrieved successfully using a novel application of a stentriever. CONCLUSIONS: In certain situations, a stentriever does not mandate complete ensnaring of the target to be retrieved and thus need not always be deployed distal to a migrated coil mass to be successful. Due to the mechanical advantage of strut-engagement, stentrievers can afford to be positioned in relatively suboptimal positions, and this is especially useful in cases involving tortuous and small distal vessels (<2 mm diameter).
BACKGROUND: Displacement of endovascular coils during endovascular embolization of an intracranial aneurysm is a potentially life-threatening complication. Several methods for coil retrieval have been described, including the use of microsnares and microforceps retrieval devices. With the recent surge of stentriever implementation in the treatment of ischemic stroke, some operators are now using such devices in the retrieval of migrated coils. We present a case of a balloon-assisted coil embolization of a communicating segment internal carotid artery aneurysm, complicated by coil migration far distally into the middle cerebral artery, which was retrieved successfully with a stentriever. To the best of our knowledge, this is the furthest migration of a coil to be successfully retrieved with a stentriever. We review conservative and invasive management of displaced coils and the technical advantages of stentrievers over retrieval devices. METHODS: The patient's medical records were retrospectively reviewed, including clinical and radiographic information. This study received institutional review board approval. RESULTS: The patient was treated with balloon-assisted coil embolization of the internal carotid artery aneurysm. The migrated coil was retrieved successfully using a novel application of a stentriever. CONCLUSIONS: In certain situations, a stentriever does not mandate complete ensnaring of the target to be retrieved and thus need not always be deployed distal to a migrated coil mass to be successful. Due to the mechanical advantage of strut-engagement, stentrievers can afford to be positioned in relatively suboptimal positions, and this is especially useful in cases involving tortuous and small distal vessels (<2 mm diameter).