A case of delayed distal coil migration after coil embolization of the ruptured cerebral aneurysm

Abstract

Objective: This is a case report of delayed distal coil migration after coil embolization of the ruptured cerebral aneurysm. Case presentation: A 68-year-old man became unconscious suddenly and was transferred to our hospital. Glasgow Coma Scale (GCS) score was E1V1M5. Head CT revealed subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) revealed an anterior communicating artery (Acom) aneurysm. Endovascular coiling of the Acom aneurysm was performed to prevent re-bleeding. under general anesthesia. Acute cardiac infarction developed on day 16, and the patient was treated in the cardiovascular department. Follow-up CT on day 38 revealed a high-density sign at the distal part of the anterior cerebral artery. No further treatment was performed since the patient was asymptomatic. Conclusions: Delayed distal coil migration may occur after coil embolization of cerebral aneurysm. X-ray examinations (CT and craniogram) were helpful for diagnosis of delayed distal coil migration after endovascular treatment of cerebral aneurysm.

A case of delayed distal coil migration after coil embolization of an unruptured distal azygos anterior cerebral artery aneurysm: A case report and literature review

“…Saguchi et al. 12 also reported an asymptomatic case in which peripheral blood flow did not stop from the migrated point, and in their case as well, many helical-type coils had been inserted in the latter phase of treatment, so the deviated coil seems likely to have been a helical type as in our case. Once the coil migrates, it may move further distally and frequent observations are necessary over time.…”

“…After the acute phase, within a week after the procedure, proliferation of vessel endothelial cells generally improve coil stability (subacute phase), 4 so delayed coil migration after coil embolization of an aneurysm, particularly in the chronic phase of several weeks or months, seems very rare. 4–13…”

“…The other type is complete displacement of the coil mass itself with the blood flow out to the distal end of the parent artery. 7,11,12,15 This type could result in parent artery occlusion with potentially serious ischemic complications if not removed promptly. 16…”

“…Rare complications of delayed coil migration can be detected after several months (Table 1), and the modality by which coil migration is detected varies. In general, MR angiography is often used for the follow-up after coil embolization; 17 on the other hand, some have reported cases in which asymptomatic distal coil migration was confirmed by CT in follow-up after the coil embolization 11,12 or by follow-up angiogram. 5,7 In our case, radiography of the skull (Figure 2(b)(a)) immediately after endovascular coil embolization and CT on day 22 after therapy was performed for routine follow-up (Figure 1(c)) revealed no particular abnormalities at that time.…”

“…2 However, delayed coil migration after coil embolization of an aneurysm is very rare, with few cases reported to date (Table 1). 4–13 We describe herein a case of delayed distal coil migration in a patient with unruptured distal azygos anterior cerebral artery (ACA) aneurysm, with subsequent confirmation of more distal coil movement. Direct flow stress from the azygos ACA to the neck appeared to have carried the untangled small helical-type coil more distally.…”