Case Of Coil Migration Research Articles

Enhancing precision in vascular embolization: evaluating the effectiveness of the intentional early detachment technique with detachable coils in complex cases

BackgroundThis study aimed to assess the effectiveness and versatility of an intentional early detachment technique with detachable coils in addressing challenging vascular embolization scenarios. This novel approach aims to provide an alternative method for achieving precise coil placement when standard methods of detachable coil placement are ineffective owing to vascular anatomy or limited available equipment.Materials and methodsThis retrospective study included 11 patients (nine males and two females; median age, 77 years) who underwent embolization procedures between October 2021 and December 2023 using the intentional early detachment technique through 1.6-Fr or 1.3-Fr microcatheters. In this technique, detachable coils were intentionally detached within the microcatheter and placed through saline flushing. The technique’s technical success, complications, and clinical success were evaluated.ResultsThe technique was applied in three distinct scenarios: tortuous vascular anatomy (four cases), inadequate system backup (three cases), and 1.3-Fr microcatheter use (four cases). The technical and clinical success rates were 100%. No complications were observed, and no cases of coil migration or malpositioning.ConclusionThe intentional early detachment technique is valuable for interventional radiologists and offers a solution for challenging vascular embolization scenarios. Its application is limited to specific circumstances; however, it can significantly enhance coil placement in complex cases, thereby contributing to improved patient care.Graphical

Embolization coils in treating postoperative bronchopleural fistula: a systematic review.

This study aims to comprehensively evaluate embolization coils in treating postoperative bronchopleural fistula (BPF). A systematic review based on PubMed, Embase, and The Cochrane Library studies was conducted. All cases receiving embolization coils in treating postoperative BPF were included. The primary outcome was the efficacy of embolization coils in achieving closure of postoperative BPF. 20 patients from 9 studies were included in this systematic review. A median number of 3 (range: 1-10) embolization coils with sealants obtained a complete closure rate of 80% in patients with postoperative BPF with sizes ranging from 2 to 3.1 mm. Three patients with BPF over 3 mm and one with multiple organ failure failed this treatment. Two cases of coil migration were reported without causing respiratory failure or fistula recurrence. Embolization coils might be considered a safe and effective bronchoscopic treatment for small postoperative BPF of less than 3 mm in size. More extensive and rigorous studies are needed to further evaluate and confirm the optimal use of embolization coils in the context of an alternative to surgical repair.

Coil migration during coronary artery fistula transcatheter embolization

Link of Video Abstract: https://youtu.be/qD-dDYr0m2U Introduction: Coronary artery fistula (CAF) transcatheter coil embolization is very effective in treating symptomatic coronary fistula and has many advantages compared to the surgical approach. Although this procedure is considerably safe, some life-threatening complications, including vessel rupture, coil migration and death, could still happen. We reported an example case of coil migration into the left anterior descending (LAD) artery during transcatheter CAF embolization. Case Description: A 61-year-old man reported recurrent episodes of typical chest pain and a history of inconclusive exercise tests. Computed tomography (CT) angiography revealed a considerable medium size complex coronary fistula from proximal LAD to main pulmonary artery (MPA), which could cause coronary steal syndrome. The patient then underwent CAF transcatheter coil embolization with 3 pushable coils. Upon delivery of the last coil, the coil suddenly migrated into proximal LAD and made the patient feel chest pain with slight ST depression on electrocardiogram (ECG) monitor lead. This coil migration was treated with a coronary stent to pin the coil into the ostial CAF and coronary vessel wall. After the procedure, the chest pain disappeared, and the ST segment on ECG resolved back to baseline. Conclusion: Coil migration is one of the potentially life-threatening complications during transcatheter CAF coil embolization. Careful preparation in choosing the closure technique, selecting coil size, determining the landing zone and using a detachable coil in high-risk CAF anatomy is mandatory to prevent this event.

Abstract 1122‐000164: Peri‐embolization Use of Stent Retrievers as a Rescue Tool in Patients with Subarachnoid Hemorrhage

Introduction : Coil migration after endovascular embolization of intracranial aneurysms is one of the periprocedural complications in 2–6% of patients. Stent retriever use is well‐established in treatment of ischemic stroke but has not been well established to address coil retrieval as rescue therapy. We describe three cases with successful removal of migrated coils using stent retrievers. Methods : A retrospective review at a single center university hospital was performed for all Neuro‐endovascular case log from December 2018 to November 2020. Cases of coil migration were reviewed and coil retraction with Stent Retriever with successful coil mass extraction was considered an endpoint. Number of attempts, types of stent retrievers used and time taken for extraction were noted. Results : Case 1: 56‐year‐old female presented with ruptured tri‐lobed 4 × 3 mm Anterior communicating artery aneurysm. Hunt and Hess (H&H) Grade 2. Modified Fisher scale (MFS) 4. Underwent primary coil embolization. Two 2mmx2cm Galaxy Orbit coils were deployed within aneurysm. During deployment of third coil the first two coils displaced out of the aneurysm migrating into left A2 segment. Stryker’s Trevo 3 × 20 mm stent retriever was used for retrieval of coils however they dislodged at the left internal carotid artery (ICA) terminus and migrated distally into the left middle cerebral artery (MCA) M2 superior division. Subsequently, Medtronic’s Solitaire 4 × 40 mm stent retriever was successfully deployed retrieving the migrated coils with full recanalization. Case 2: 64‐year‐old female presented with ruptured 3 × 5.3 mm right posterior communicating artery (Pcom) aneurysm. H&H 5 and MFS 4. Underwent primary coil embolization with placement of Galaxy Orbit 2.5mmx3.5cm coil. On follow up run, coil mass had migrated into the origin of right fetal Pcom. Migrated coil was successfully retrieved using Stryker’s 4 × 40 mm stent retriever with complete recanalization. Case 3: 65‐year‐old female with presented ruptured 8.5 × 6.8 mm right supraclinoid ICA irregular aneurysm. H&H Grade 1. MFS 3. Underwent primary coil embolization with one Galaxy coil (5mm x 10cm) with plan for future flow diversion. Two weeks later, patient experienced acute neurological worsening with new left sided hemiparesis and right gaze deviation. Imaging revealed acute occlusion of right middle cerebral artery M1 segment occlusion with thrombosed migrated coil. Patient underwent retrieval of the coil and superimposed thrombus utilizing Stryker’s Trevo (4*30 mm) stent retriever with resultant full recanalization. Conclusions : These cases demonstrate successful endovascular mechanical removal of migrated coils using stent retrievers. They add to the limited experience of stent retrievers utilization as effective tools for dealing with such complications.

Posterior Internal Frontal Artery Vascularization of the Precentral Gyrus Responsible for Proximal Arm Movement: Insight from a Case of Coil Migration

Our knowledge of the vascularization of the precentral gyrus by branches of the anterior cerebral artery (ACA) relies mainly on anatomical cadaveric dissection. A distal branch of the ACA known as the posterior internal frontal artery (PIFA) is thought to vascularize the precentral gyrus responsible for proximal arm movement; however, no clinical correlation has yet been reported to confirm this relation. In this manuscript, we report a case of coil migration in the PIFA, causing proximal arm weakness in a 58-year-old woman treated for aneurysmal subarachnoid hemorrhage. The occurrence of clinical signs immediately following coil migration into the PIFA, combined with evidence of stroke in the cortical territory related to arm movement as seen on imaging, indicates that the PIFA indeed can vascularize this lateral portion of the precentral gyrus. This case confirms our current understanding of the vascularization of the precentral gyrus by distal ACA branches, in particular the PIFA.

Inadvertent Migration of Hepatic Artery Pseudoaneurysm Coil during Endoscopic Retrograde Cholangiopancreatography

We report a case of a 72-year-old male with a cascade of complications being diagnosed as an acute cholecystitis. The cascade includes iatrogenic pulling of coils, which were placed for treatment of right hepatic artery pseudoaneurysm, into the common bile duct (CBD) in an attempt for removal of the misplaced/migrated CBD plastic stent inserted by endoscopic retrograde cholangiopancreatography (ERCP). The case demonstrates a series of mishaps leading to a rare complication of iatrogenic migration of transarterial coil in the gastrointestinal tract. This could be the first case of coil migration as a complication of ERCP due to suboptimal stenting/removal techniques.

Analysis of Complications Related to Endovascular Therapy for Dural Arteriovenous Fistulae

In this paper, we reviewed our cases of dural arteriovenous fistulae (dural AVFs) and analyzed periprocedural complications. In 157 procedures, we encountered 14 complications. Overall, complication rate of 9% was seen.We divided these complications into five subgroups such as cranial nerve palsy, coil-related trouble, thromboembolic complication, vessel perforation, and radiation-related trouble. There were five transient abducent nerve palsies in cases with cavernous sinus dural AVFs. There were two cases of coil unraveling and two cases of coil migration. In two cases, direct puncture of the internal jugular vein was performed to retrieve the unraveled coil by using dual microcatheter and guidewire snare technique. We encountered two thromboembolic complications. In one case, venous infarction was recognized after polyvinyl alcohol particle embolization. In two cases of vessel perforations, there were no new neurological deficits except one case with transient Gerstmann syndrome. In endovascular treatment of dural AVF, serious complications are rare and can be prevented if maximum attention is paid during the procedure.

Problems in Endovascular Procedures in Acute Ruptured Intracranial Aneurysms

Fifteen patients with acute ruptured intracranial aneurysms were treated with interlocking detachable coil (IDC) embolization. All graded poorly, i.e., Hunt & Kosnik grades IV and V. Aneurysm occurred in the anterior circulation in 14 patients and at the basilar tip in one, of these, 13 were small and 2 large. The endovascular procedure was conducted in a transfemoral approach under local anesthesia. Aneurysmal obliteration was examined transitionally after embolization. Final outcome was evaluated using the Glasgow outcome scale (GOS). Total aneurysmal occlusion was observed immediately after IDC embolization in 11 patients. Two cases of coil migration to the parent artery occurred during endovascular procedure in patients with severe atherosclerosis. Aneurysmal rupture occurred during the endovascular procedure in a small internal carotid artery aneurysm when coil detachment failed. Follow-up angiography showed coil compaction in 2 patients, one patient experienced deterioration when the aneurysm ruptured. Eleven patients (73.3%) retained total aneurysmal occlusion and had no rebleeding. The overall GOS indicated good recovery in 5 patients, severe disability in 2, persistent vegetative state in 2, and death in 6. IDC embolization in severe acute ruptured intracranial aneurysm successfully prevented rebleeding, but our series was limited by the very small aneurysm size and the presence of severe atherosclerosis.

Pulmonary embolism after percutaneous embolization of left spermatic vein

Embolization of the spermatic vein is regarded as a safe and reliable method for treating a varicocele [l-13]. A variety of techniques is used for percutaneous occlusion of veins making use of stainless steel coils, coils with polyester fibre strands (Gianturco), detachable balloons or sclerosing agents. Complications are reported in l-30% of cases [2,3]. These complications consist of perivenous contrast extravasation, testicular thrombophlebitis, flank pain, venous spasm, puncture of femoral artery, contrast reaction, stripping of intima, capture of catheter in thrombus and migration of obstructing device [ 1,3-61. In the literature four complications due to migration or inadequate positioning of obstructing devices are reported [2,6-91. In one case a detachable balloon was left in a spasmic vein, and dislodgement occurred when the venous spasm subsided [2,7,8]. Two authors mention protrusion of the tail of the coil into the renal vein [ 6,9]. In one case the coil could be manipulated into the left spermatic vein [ 61. In the other patient the coil had to be surgically removed [ 91. Another author reported on pulmonary embolism of a plastic sheath used to straighten the guide wire [ 3,10,11]. Clinical sequelae were detected in none of these cases. We report on a case of coil migration following percutaneous transfemoral obliteration of left spermatic vein using Gianturco coils.