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Muninthorn W, Kobkitsuksakul C, Boongird A. Emergency surgical removal of a migrated coil during embolization of a giant internal carotid artery aneurysm: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22287. [PMID: 36051775 PMCID: PMC9426351 DOI: 10.3171/case22287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/27/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
| | - Chai Kobkitsuksakul
- Division of Interventional Neuroradiology, Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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2
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Chapot R, Stracke CP, Wallocha M, Rikhtegar R, Yamac E, Mosimann PJ. Bailout stentectomy of 47 self-expandable intracranial stents. J Neurointerv Surg 2021; 14:160-163. [PMID: 33722969 PMCID: PMC8785071 DOI: 10.1136/neurintsurg-2021-017279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
Abstract
Background Self-expanding stents are increasingly being deployed for stent-assisted coiling or flow diversion of intracranial aneurysms. Complications related to stent misbehavior may arise, however, including lack of expansion, device displacement, or parent vessel thrombosis. We present our experience of various stent removal techniques (stentectomy) with a focus on technical and clinical outcomes. Methods Stentectomy was attempted either with a single device, including the Alligator, Microsnare, or Solitaire, or by combining a Microsnare with a second device. Dual techniques included in this report are the Snare-over-Stentretriever technique we developed using a Microsnare and a Solitaire, and the previously described Loop-and-Snare technique using a Microsnare and a microwire. The technical success and complication rate, as well as the clinical outcome using the mRS were analyzed. Results Forty-seven stentectomies were attempted in 36 patients treated for 37 aneurysms. Forty-two devices (89.3%) were successfully retrieved. Single-device stentectomy was successful in 34% of cases, compared with 74% with dual-device techniques. Of the 20 patients with a thrombosed parent or efferent vessel, 17 were successfully recanalized using stentectomy. All successful stentectomy patients made a clinically uneventful recovery, except one with a minor postoperative stroke (mRS 1 at discharge). Failed stentectomy was associated with major ischemic stroke in two patients and death in one patient. There were no stentectomy-related vessel perforations or dissections. Conclusion While various single devices can be used to safely retrieve dysfunctional intracranial self-expandable stents, dual-device techniques are more than twice as effective, according to our experience.
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Affiliation(s)
- René Chapot
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Christian Paul Stracke
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Marta Wallocha
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Reza Rikhtegar
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Elif Yamac
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Pascal John Mosimann
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
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Stanzani R, Yamada Y, Kawase T, Devareddy G, Kadam C, Shukurov F, Vaibhav C, Kato Y. Acute Coils Migration Causing Significant M3 Branch Occlusion: A Case Report of Rescue Surgery with Superficial Temporal Artery-Middle Cerebral Artery Bypass. Asian J Neurosurg 2020; 15:428-430. [PMID: 32656147 PMCID: PMC7335151 DOI: 10.4103/ajns.ajns_349_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/03/2020] [Accepted: 04/09/2020] [Indexed: 11/17/2022] Open
Abstract
We describe an uncommon case of acute coils migration with significant occlusion of M3 branch and our management of this complication. Ballon-assisted coil placement was performed for an unruptured intracavernous internal carotid artery aneurysm in a 62-year-old woman. After coil placement and balloon deflection, we observed coils migration with significant occlusion of M3 branch. After early clinical deterioration without other neurological symptoms, we decided to perform superficial temporal artery-middle cerebral artery (STA-MCA) bypass to ensure blood flow distal to the occlusion. The patient was discharged without neurological deficit. To the best of our knowledge, this is the first case report about STA-MCA bypass to treat acute coils migration. This technique could represent a successful rescue therapy in case of acute coils migration that cannot be retrieved by endovascular tools or in case where distal and deep location of migrated coils controindicate surgical removal.
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Affiliation(s)
- Riccardo Stanzani
- Department of Neurosurgery, Neurosurgery Unit AOU Policlinico di Modena - OCSAE Modena Hospital, Modena, Italy.,Department of Neurosurgery, Neurosurgical Residency Program, University of Padua, Padua, Italy.,Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Tukasa Kawase
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Gowtham Devareddy
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Chandratej Kadam
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Firuz Shukurov
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Chavan Vaibhav
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan.,Department of Neurosurgery, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Yoko Kato
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
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Abdalkader M, Piotin M, Chen M, Ortega-Gutierrez S, Samaniego E, Weill A, Norbash AM, Nguyen TN. Coil migration during or after endovascular coiling of cerebral aneurysms. J Neurointerv Surg 2019; 12:505-511. [PMID: 31662464 DOI: 10.1136/neurintsurg-2019-015278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Coil migration is a complication of endovascular coiling of cerebral aneurysms that has not been well studied. OBJECTIVE To report the frequency, risk factors, management strategies, and outcomes of coil migration. METHODS This was a retrospective analysis of the clinical and radiological data of patients who underwent cerebral aneurysm coiling complicated by coil migration at five neuroendovascular centers in the United States, Canada, and France between 2008 and 2018. RESULTS Eighteen cases of coil migration met our study criteria with an occurrence of 0.3% (18/6071 cases) (procedural migration: 55%, delayed migration: 45%). The mean aneurysm maximal diameter, neck, and height to neck ratio in migration cases were 3.4±1.4 mm (range 2-7.6 mm), 2.4±0.9 mm (range 1.2-4.4 mm), and 1.4±0.4 (range 1-2.15), respectively. The 2 mm diameter coil was the most common (39%, range 1-2.5 mm) migrated coil. The length of the migrated coil was ≤4 cm in 95% of cases.Patients managed conservatively (5/18, 28%) did well. Thromboembolic and/or hemorrhagic complications were noted in 6/10 migration patients treated by endovascular modalities and in all migration patients who underwent surgical treatment (4/4). Three deaths occurred (3/18, 17%) related to high Hunt and Hess grade subarachnoid hemorrhage. CONCLUSION Coil migration is an uncommon but important complication of cerebral aneurysm coiling. Small aneurysms, aspect ratio <1.6, and small coils are significant risk factors. Endovascular treatment, such as using a stent retriever, can be considered for procedural, proximal migration, and/or in cases of vessel occlusion. Delayed or distal migration should be managed conservatively.
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Affiliation(s)
- Mohamad Abdalkader
- Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Edgar Samaniego
- Neurology, Radiology and Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Alain Weill
- Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | | | - Thanh N Nguyen
- Neurology, Radiology and Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA
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Kwon HJ. Removal of a Distally Migrated and Wedged Small Detachable Coil Using a 4MAX Penumbra Reperfusion Catheter. Clin Neuroradiol 2018; 29:563-565. [PMID: 30564839 DOI: 10.1007/s00062-018-0753-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Hyon-Jo Kwon
- Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Medical School and Hospital, 282 Munhwa-ro Jung-gu, 35015, Daejeon, Korea (Republic of).
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Tsang ACO, Nicholson P, Pereira VM. Nickel-Related Adverse Reactions in the Treatment of Cerebral Aneurysms: A Literature Review. World Neurosurg 2018; 115:147-153. [PMID: 29684517 DOI: 10.1016/j.wneu.2018.04.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Nickel is the most common metal allergen and predominantly affects women. It is also the ubiquitous component in the alloys used to manufacture intracranial devices for aneurysm treatments, including aneurysm clips, self-expanding stents, flow-diverting stents, and endosaccular occlusion devices. Adverse events related to nickel allergy after deployment of such devices are uncommon but can be severe, resulting in dilemmas in the choice of treatment strategies and devices in managing nickel-sensitive patients with intracranial aneurysms. METHODS A literature search was performed in accordance with the PRISMA guidelines to identify studies reporting on nickel-related adverse events in patients being treated for cerebral aneurysm. The materials of the culprit devices, clinical presentation, histological features, and treatments were reviewed. Clinical considerations and management options for nickel allergy patients were evaluated. RESULTS Nickel is a major component of the cobalt alloy used in aneurysm clips and also of nitinol, which is commonly used in flow diverters and intracranial stents. Our literature review identified 9 articles reporting 10 unique cases of nickel-related adverse events after aneurysm treatment. Five of the cases occurred after aneurysm clipping, and the other 5 were attributed to endovascular devices. Two patients presented with dermatologic manifestations and 8 with neurologic manifestations, including cerebral edema and cerebritis. CONCLUSIONS Neurologic complications related to nickel in cerebral aneurysm treatments are rare but remain concern owing to the high prevalence of nickel allergy in the population. Surgeons and interventionists should consider the metal allergy history and its potential clinical significance in managing nickel-allergic patients with aneurysms.
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Affiliation(s)
- Anderson Chun On Tsang
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Symptomatic delayed coil migration after balloon assisted embolization: An underreported adverse event? Neurocirugia (Astur) 2018; 30:87-93. [PMID: 29625853 DOI: 10.1016/j.neucir.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/27/2018] [Accepted: 02/18/2018] [Indexed: 11/22/2022]
Abstract
Microsurgical clipping is still regarded as the gold-standard treatment for broad-neck intracranial aneurysms. New endovascular techniques like balloon or stent assisted coiling are quickly rising to the challenge and showing promising outcomes. As a result, broad-neck aneurysms are increasingly addressed by these techniques despite they have not been tested against clipping in a randomized controlled trial and long-term complications might be unknown yet. Intraprocedural coil migration has been well documented in the literature, but the same complication in a delayed fashion is scarcely reported. We present a case of delayed coil migration occurring after a balloon-assisted embolization of a wide-necked intracranial aneurysm and we perform a literature review for similar cases. We discuss how, despite seeming an extremely rare complication, with new endovascular techniques increasingly perceived as the safer option in any aneurysm, potential adverse events may become more frequent. Strategies proposed to address this developing scenario are also reviewed.
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Wang T, Zhang C, Xie X. Delayed Coil Migration After Treatment of Traumatic Pseudoaneurysm. World Neurosurg 2017; 113:206-207. [PMID: 29258948 DOI: 10.1016/j.wneu.2017.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 02/05/2023]
Abstract
A teenager with epistaxis after head trauma was diagnosed with pseudoaneurysm of the internal carotid artery. Three years after the first aneurysm embolization, delayed coil migration was detected. Then the migrated coil was removed through nasal endoscopy.
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Affiliation(s)
- Ting Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Changwei Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Xie
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
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Endovascular stentectomy using the snare over stent-retriever (SOS) technique: An experimental feasibility study. PLoS One 2017; 12:e0178197. [PMID: 28542580 PMCID: PMC5444789 DOI: 10.1371/journal.pone.0178197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 05/08/2017] [Indexed: 11/19/2022] Open
Abstract
Feasibility of endovascular stentectomy using a snare over stent-retriever (SOS) technique was evaluated in a silicon flow model and an in vivo swine model. In vitro, stentectomy of different intracranial stents using the SOS technique was feasible in 22 out of 24 (92%) retrieval maneuvers. In vivo, stentectomy was successful in 10 out of 10 procedures (100%). In one case self-limiting vasospasm was observed angiographically as a technique related complication in the animal model. Endovascular stentectomy using the SOS technique is feasible in an experimental setting and may be transferred to a clinical scenario.
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Delayed asymptomatic coil migrations toward different arteries after aneurysmal embolization: case report. Acta Neurochir (Wien) 2017; 159:593-598. [PMID: 28110403 DOI: 10.1007/s00701-017-3083-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
Delayed coil migration after endovascular treatment with detachable coils, particularly several months after treatment, is extremely rare. In this report, the authors describe a 77-year-old female in whom delayed coil migration to the anterior cerebral artery and posterior communicating artery (PCoA) developed 3 months after an uncomplicated aneurysm embolization. The patient was successfully retreated with a closed-cell stent. Computational fluid dynamics (CFD) revealed high wall shear stress (WSS) and multiple vortices in the residual cavity of the initially treated aneurysm. CFD could be useful to detect and predict this complication, and a stent-assisted technique could be an important treatment option.
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Turek G, Lewszuk A, Kochanowicz J, Lyson T, Zielinska-Turek J, Gorbacz K, Mariak Z. Early outcomes and perioperative complications of endovascular embolization in patients with aneurysmal SAH. Neurol Neurochir Pol 2016; 50:342-8. [PMID: 27591059 DOI: 10.1016/j.pjnns.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/14/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We still lack reliable data on the outcomes of endovascular coiling for ruptured cerebral aneurysms. As this is still an evolving technique, the outcomes of the procedures performed in the past and more recently cannot be directly compared. We present the early outcomes of endovascular coiling in a relatively large group of patients with ruptured intracranial aneurysms. METHOD The study included 190 consecutive patients (a total of 216 aneurysms) subjected to endovascular coiling in 2006-2013 (127 women aged 56±13 years and 63 men aged 50± 15 years). Up to 87.5% of the aneurysms were located within anterior circulation. Most patients presented with "mild to moderate" subarachnoid hemorrhages (85% of Hunt &Hess scores 1-3, and 72% of Fisher scores 1-3). RESULTS Embolization was feasible in 176 (92.6%) patients. In 14 cases, the embolization was not attainable due to unfavorable anatomy of the aneurysm, intraoperative vasospasm and/or aneurysm rupture, or prolapse of a coil. Early complications related to the procedure were recorded in 23 (13.1%) patients. The most common perioperative complication was aneurysm rupture. All fatal complications occurred in patients with aneurysms located at the anterior circle of Willis. At the time of discharge, 126 patients scored 4 or 5 on the Glasgow Outcome Scale. CONCLUSIONS Endovascular embolization is an effective and relatively safe method for treatment of ruptured cerebral aneurysms. Complications related to the procedure are significantly less frequent in the case of vertebral-basilar complex aneurysms.
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Affiliation(s)
- Grzegorz Turek
- Department of Neurosurgery, Medical University of Bialystok, Bialystok, Poland.
| | - Andrzej Lewszuk
- Department of Radiology, Medical University of Bialystok, Bialystok, Poland
| | - Jan Kochanowicz
- Department of Invasive Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Tomasz Lyson
- Department of Neurosurgery, Medical University of Bialystok, Bialystok, Poland
| | | | - Krzysztof Gorbacz
- Department of Neurosurgery, Medical University of Bialystok, Bialystok, Poland
| | - Zenon Mariak
- Department of Neurosurgery, Medical University of Bialystok, Bialystok, Poland
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