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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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Maeda K, Motoie R, Karashima S, Otsuji R, Ren N, Nagaoka S, Ikai Y, Uno J, Gi H. A case of delayed distal coil migration after coil embolization of an unruptured distal azygos anterior cerebral artery aneurysm: A case report and literature review. Interv Neuroradiol 2018; 24:643-649. [PMID: 29871560 DOI: 10.1177/1591019918780465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Intraprocedural coil migration during endovascular treatment for an aneurysm that might carry serious ischemic complications is well known. On the other hand, delayed coil migration after endovascular treatment for an aneurysm is very rare. A 77-year-old woman was incidentally diagnosed with unruptured aneurysm associated with distal azygos anterior cerebral artery (ACA). The aneurysm was located at the distal bifurcation of the azygos ACA and was wide necked (approximately 7 mm in diameter). Endovascular coil embolization was selected and the aneurysm was occluded successfully, but 29 days after endovascular therapy, follow-up computed tomography (CT) and magnetic resonance (MR) angiography revealed distal coil migration in the peripheral portion of the ACA. In addition, CT on day 57 after therapy revealed the migrated coil had moved more distally. Fortunately, in the course of these events, the patient remained asymptomatic. To the best of our knowledge, this represents the first case of delayed distal coil migration associated with relatively rare azygos ACA aneurysm, and also the first report confirming more distal coil movement over time. In the future, a large number of patients could develop this complication as more aneurysms are aggressively treated with endovascular treatment. Knowledge regarding the possibility of delayed coil migration is thus important.
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Affiliation(s)
- Kazushi Maeda
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Ryota Motoie
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Satoshi Karashima
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Ryosuke Otsuji
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Nice Ren
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Shintaro Nagaoka
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Yoshiaki Ikai
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Junji Uno
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Hidefuku Gi
- Department of Neurosurgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
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Unruptured medial paraclinoid internal carotid artery aneurysm embedded within symptomatic nonfunctioning pituitary giant adenoma: A high-risk comorbid pathology in transsphenoidal surgery and its countermeasures. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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