Coil Extrusion into the Naso- and Oropharynx Ten Years after Internal Carotid Artery Pseudoaneurysm Embolization: A Case Report

Abstract

Coil migration and extrusion outside the cranial compartment after embolization of cerebral aneurysms represents a very rare complication of the endovascular procedures and few cases are reported in the literature. Instability of the vascular malformation wall and the resolution of the intramural hematoma, especially in pseudoaneurysm, might generate extravascular migration of the coils in the first months after embolization. However, to the best of our knowledge, an extrusion of coil 10 years after embolization has never been reported. We reported the unique case of a patient with coil extrusion into the naso- and oropharynx 10 years after internal carotid artery pseudoaneurysm embolization. The pseudoaneurysm occurred after an internal carotid artery injury during an endoscopic endonasal surgery for a clival giant cell tumor.

Lateral Sinus Thrombosis as a Complication of Acute Otitis Media, Clinical Case Report in Bogotá, Colombia

“…Conservative measures in cases such as these fail to address the worrisome infection risk and prophylactic anti-staphylococcal antibiotics are reasonable in the pre-operative and immediate post-operative period. Additional monitoring for prosthetic colonization and failure is likely warranted with one case report regularly following up until 6 months [5]. As endovascular coiling becomes more and more common, only time will tell if the incidence of coil erosion into the aerodigestive tract will increase.…”

“…Several cases (Table 1) [3,4] have been reported in the literature following endovascular coiling of a traumatic pseudoaneurysm presenting within 6 weeks of coiling. Others have reported this as a late complication 10 years after coiling [5].…”

“…Vascular surgery was consulted who recommended removal of the extruding filament within the nasopharynx using an endoscopic approach to reduce the potential communication with the internal vasculature. Open removal of the foreign body was reserved as a last resort given the potential significant morbidity associated with extruded coil at the level of the defect while leaving the embedded portions in place [3][4][5]. This can be applied to endovascular coil erosion in true aneurysms as well and represents a pragmatic approach to treatment.…”

Cavernous Internal Carotid Artery Aneurysm: Giant Posttraumatic Carotid Cavernous Pseudoaneurysm, Presenting with Epistaxis; Treated in Two-Stage Strategy with Complete Occlusion and Delayed Coil Extrusion Through the Nostril

“…Coil extrusion into the nostril and oropharynx up to 26 months after neurointerventional therapy was reported in two cases (Struffert et al 2009). Nasi et al (2019) reported on a case in which coil extrusion had actually happened 10 years after the treatment was conducted.…”

“…Some authors reported iatrogenic perforation of the aneurysmal wall during coiling (Aoun et al 2013) or the force of blood flow compressing the coils against the aneurysmal dome resulting in coil extrusion either through an already vulnerable site or by creating a new tear in the aneurysm wall (Wilseck et al 2018). The mechanics and process described above usually take time and reflect the fact that the extrusion is reported from several months to years after the endovascular coiling procedure (Nasi et al 2019). Extruded including axial T1WI (a), axial T2WI (b), and sagittal T2WI (c) showed a modification in the signal intensity of the thrombus.…”