Stent Management of Coil Herniation in Embolization of Internal Carotid Aneurysms

Abstract

BACKGROUND AND PURPOSE:Coil herniation into the parent artery after detachment is an uncommon complication of embolization of the intracranial aneurysm. We report our experience with stent reconstruction of the lumen and flow of the internal carotid artery (ICA) after coil herniation during embolization for intracranial ICA aneurysms and the possible mechanisms of coil herniation.

Early surgical removal of migrated coil/stent after failed embolization of intracranial aneurysm

“…20,21 Endovascular or even conservative treatment options are often also considered in such situations. 4,5,13,14,15 Migration of a coil or undeveloped stent to a distant MCA is a rare condition. Only 4 reports of such complications have been published thus far, among them 1 case report from our center; this was the first published case in which a distally migrated coil was successfully evacuated from the MCA with the aid of the technique presented in the current paper.…”

Stent-Supported Aneurysm Coiling: A Literature Survey of Treatment and Follow-Up

“…Twenty-seven papers [2][3][4][5]7,[9][10][11]13,[15][16][17][18]20,24,25,[28][29][30][33][34][35][36][37][38][39][40] , containing 736 patients, reported clinical follow-up of 13-month average duration and 6-month median duration. Twenty-one patients (3.2%) suffered delayed TIA/stroke in the territory subserved by the stented vessel.…”

Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms

“…Luo et al 4 administered both aspirin and clopidogrel for 3-6 months after stent placement in 9 patients with large coil protrusions. 4 …”

“…1 An infrequent occurrence during endovascular treatment is protrusion of detachable coils into the parent lumen with a subsequent thrombosis within the parent vessel or embolic events. [2][3][4] Overall, thromboembolic complications occur in 2.5%-28% of cases with a variable and often uncategorized component related to coil protrusion. 6,7 Coil protrusion may result from size mismatch between the coils and aneurysm, inadequate position of the microcatheter within the aneurysm, and/or wide-neck aneurysms.…”

“…6,7 Coil protrusion may result from size mismatch between the coils and aneurysm, inadequate position of the microcatheter within the aneurysm, and/or wide-neck aneurysms. 4,5 Several techniques for managing coil protrusions into parent vessels have been described in case reports, including removal and repositioning of the coil before electrolytic detachment, 3 removal of an already-detached coil by using a snare, 2,[10][11][12] repositioning or redirecting the protruding coil by using balloon inflation, 8,9,13 or stent reconstruction of the lumen of the parent vessel. 3,4,14 We report the shortand intermediate-term angiographic and clinical outcomes of a consecutive series of patients who experienced coil protrusion and were managed with medical or additional endovascular treatments, with emphasis on the magnitude of the protrusion.…”