Coil Retrieval following Embolization of Cerebral Aneurysms

Abstract

<jats:p> Failed coil embolization of cerebral aneurysms may be occasionally followed by direct surgical treatment. We had 5 patients who underwent coil retrieval and surgical clipping after coil embolization because of periprocedural complications. The patients, ranging in age from 40 to 71, had wide-neck aneurysms located at the anterior communicating artery (AcomA) in 3 patients, the middle cerebral artery (MCA) in 1, and the internal carotid-ophthalmic artery (IC-Ophthalmic) in 1. They were embolized with Guglielmi detachable coils (GDCs), which had to be retrieved within 8 days because of coil protrusion and migration in 3 patients, aneurysm rupture in 1, and increased mass effect due to coil compaction in 1. Coils were successfully removed with aneurysmotomy or arteriotomy under temporary trapping, aneurysms were then clipped or trapped. Three patients had a good outcome, but one suffered permanent visual disturbance and the other had a motor deficit. Our study revealed that a small AcomA aneurysm had a high risk of complication in a case of complex anatomy of the AcomA-A1-A2 complex with its difficult access. In addition, insufficient packing of the inflow zone in a large and symptomatic aneurysm may cause coil compaction and regrow with increasing mass effect. </jats:p><jats:p> The indication and treatment strategy for these aneurysms should be carefully determined. </jats:p>

Late Coil Migration after Embolization of Cerebral Aneurysms – Case Series

“…Severe neurological consequences have been described in other reports. 4,6,7 One case demonstrated that coil migration represents a rare but potentially severe complication of cerebral aneurysm embolization. A man with subarachnoid hemorrhage had a delayed (8 days after the procedure) migration of a coil loop after adjunctive balloon remodeling of an anterior communicating artery (AComA) aneurysm causing ischemia on the anterior cerebral artery and paresia of the lower extremity.…”

“…There was reversal of symptoms, because the main source of ischemic symptoms is the formation of small emboli around the migrated spirals. 4 Ding et al 8 identified 16 publications with 37 reported cases of migrated coil retrieval consisting of 10 case reports and 6 case series. Most of the aneurysms presented with rupture (65%) and were located in the anterior circulation (70%), but the migration occurred and was seen during the procedure.…”

“…An antiplatelet regimen should be used until endothelialization of the coil, but the aneurysm treatment must be completed if there is a residual neck. 4 Our standard antiplatelet regimen comprises 100 mg of ASA and 75 mg of Clopidogrel daily, only for wide neck aneurysms that will receive a stent. They are started at least 10 days before the elective procedure.…”

“…The migrated coils can form thrombi, which may cause distal vessel occlusion. 4 If the patients with minimal coil protrusion have no ischemic symptoms, they may be treated with persistent systemic anticoagulation. However, in cases of symptomatic protrusion or coils migration, the patients must be recovered through endovascular procedure or surgery to avoid a new ischemic problem.…”

“…However, in cases of symptomatic protrusion or coils migration, the patients must be recovered through endovascular procedure or surgery to avoid a new ischemic problem. 4 There is no standard recommended method of coil displaced retrieval. Any evidence of embolic phenomena or thrombus aggregation related to the coil requires intervention.…”