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  • Manual Aspiration Technique to Retrieve a Prematurely Detached Coil During Cerebral Aneurysm Embolization

    Final Number:
    281

    Authors:
    David A. Stidd MD MS; Andrew Kelly Johnson MD, MS; Demetrius K. Lopes MD

    Study Design:
    Other

    Subject Category:
    Cerebrovascular

    Meeting: AANS/CNS Cerebrovascular Section 2014 Annual Meeting

    Introduction: Coil herniation, premature deployment, and fracture are procedure associated complications of endovascular aneurysm embolization that optimally necessitate coil retrieval when feasible. Several published techniques describe different strategies for managing coil complications including various snare retrieval devices, alligator retrieval devices, stent fixation, and open surgical resection of coils when distal blood flow is compromised. We report a technique employed to retrieve a prematurely detached coil during an aneurysm embolization.

    Methods: A case report is presented.

    Results: A patient with an incidental basilar tip aneurysm was treated using a stent-assisted coil embolization procedure. After the first coil was satisfactorily deployed through a stent placed at the aneurysm neck, only half of a second coil could be delivered into the aneurysm before the microcatheter position was lost. On attempting to retrieve the coil back into the microcatheter, the coil prematurely detached from the pusher wire with the proximal end of the coil remaining in the microcatheter. The pusher wire was then withdrawn and a 20 ml syringe was fixed to the microcatheter. With careful aspiration under fluoroscopic visualization, the detached coil was retrieved through the microcatheter, disengaging it from aneurysm coil mass without disruption (Figure 1).

    Conclusions: The aspiration technique described here was successfully used to retrieve a detached coil that remained inside of the microcatheter. This is a safe technique to have a strategy to retrieve loose coils under this particular circumstance.

    Patient Care: This will give the endovascular surgeon another strategy to retrieve a prematurely detached coil under specific circumstance.

    Learning Objectives: To learn a new technique to retrieve a prematurely detached coil during coil embolization.

    References:

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