Endovascular Retrieval of Dislodged Neurovascular Devices with a Stentriever: Case Series and Technical Review

Retrieval of Migrated Coils From Distal Cerebral Vasculature Using Stent Retriever: A Case Series

The incidence of coil dislocation during an endovascular embolization of intracranial aneurysm is low but it can lead to serious thrombo-embolic complications. Therefore, coil displacement/migration often requires either retrieval or fixation of the errant coil with a stent. There are no standard recommended methods of coil retrieval. We present a series of three cases in which off-label application of a stent retriever allowed successful retrieval of herniated coils.

Emergency surgical removal of a migrated coil during embolization of a giant internal carotid artery aneurysm: illustrative case

BACKGROUND

Coil migration during endovascular treatment for an intracranial aneurysm is rare. When it occurs intraoperatively, it often mandates prompt endovascular retrieval or, as a salvage maneuver, microsurgical extraction if it fails endovascularly.

OBSERVATIONS

The authors presented a case of immediate coil migration during embolization of a giant intracranial cavernous segment of the internal carotid aneurysm. The patient immediately underwent emergency surgical extraction after unsuccessful endovascular retrieval attempts. The migrated coil was successfully removed through the M1 segment of the middle cerebral artery. The patient had full recovery without new neurological deficits. Four years after the incident, she was living independently. Previous case reports of emergency surgical removal of immediate coil migration were provided.

LESSONS

Surgical extraction of migrated coil after unfeasible endovascular retrieval served as an alternative salvage procedure. Hybrid neurological angiography in the operating suite may prevent unnecessary transfer and provide better real-time visualization of the migrated coil.

Application of the Neuroform Atlas Stent in Intracranial Aneurysms: Current Status

The Neuroform Atlas stent (NAS) is the successor of the Neuroform EZ stent. The NAS is compatible with a low-profile 0.0165-inch microcatheter and is soft enough to pass through small and highly tortuous vessels. The NAS can be used in treating intracranial aneurysms at almost all locations, and its use is becoming increasingly common. However, there has not yet been a complete review of NAS applications. Therefore, we performed this review, which addresses several aspects of the NAS, mainly including its characteristics, clinical trials of its application in treating aneurysms, deployment techniques for the device, the prognosis and complications of its application in treating aneurysms, and antiplatelet requirements associated with its use. Based on the evidence reviewed here, as well as our experience, we found that the NAS is a promising device for treating intracranial aneurysms, especially complex and distal aneurysms. This stent can also be used as a powerful tool to assist in rescuing coil migration, completing dual-stent reconstruction, and coiling aneurysms via a transcirculation approach. The device may require antiplatelet therapy at a lower dose and over a shorter period than other stents. The deployment of the NAS to assist in aneurysm coiling can yield good clinical outcomes and an acceptable rate of complications. Thus, the NAS is a promising device.

Rescue Maneuver of Migrated Coil Using the ERIC Device after Previous Attempts with Conventional Stentrievers

Coil prolapse or migration is a rare but potentially serious complication that may occur during aneurysm embolization, with no standard management currently described. Here we describe our experience with the Embolus Retriever with Interlinked Cages (ERIC) device^® (Microvention, Aliso Viejo, CA, USA) for the retrieval of prolapsed or migrated coils in a case series and Flow-Model analysis. First, a retrospective review was performed using our institution database for patients in which coil prolapse or migration occurred during aneurysm embolization, and data was collected and analyzed. Second, an in vitro Flow-Model analysis was performed comparing the ERIC device^® with other stent retrievers for coil retrieval. In 2 cases, the ERIC device^® successfully retrieved the displaced coil from intracranial circulation in 1 pass, after failure with other devices. In the Flow-Model, again the ERIC device^® achieved success for retrieving a detached coil, whereas 2 other different stent retrievers failed to capture the coil after 2 attempts. The ERIC device^® appears to be a safe and effective tool for retrieving a prolapsed or migrated coil from the intracranial circulation.