Introduction: On the basis of the increasing number of endovascular procedures, the figures of interventional related complications during aneurysm treatment are rising. Coil migration with the risk of cerebral ischemia and impending neurological deficits is a rare but severe complication, and have to be handled as an interdisciplinary emergency.
Methods: This report details the interdisciplinary management in totally eight patients with coil migration during endovascular treatment of unruptured intracranial aneurysms. The detailed microsurgical procedures for successful removal of the migrated coils are presented. Three different microsurgical strategies for successful coil removal are shown: 1) the indirect approach through the aneurysm, 2) the direct approach to the migrated coils via arteriotomy with complete coil removal and 3) with partial coil removal.
Results: In order to restore cerebral blood flow (CBF) as soon as possible, different treatment strategies with total removal of all coils or retrieval of the migrated coil alone and consecutive clip occlusion of the aneurysm were performed. The type of the arterial incision and technique of arterial reconstruction is important. Inevitably, the further management of the aneurysm occlusion have to be determined. Intraoperative angiography or fluorescence angiography is recommended to show the current situation of the residual coils within the aneurysm and the CBF. Also intraoperative microdoppler is necessary to monitor blood flow and especially, to detect thromboembolic vessel occlusion immediately after the coil removal or after the suture of the arteriotomy. The postoperative outcome of a series of totally 8 patients was evaluated, and the mentioned different surgical strategies are presented in 3 representative cases.
Conclusions: A perfect interdisciplinary cooperation is the prerequisite of successful treatment in these rare complications with rapid cerebral revascularization as an overall goal.
Patient Care: Demonstration of emergency microsurgical strategies
Learning Objectives: surgical strategy in patients with coil Migration
endovascular and microsurgical cooperation
References: Quantifying unruptured giant intracranial aneurysms by measuring diameter and volume--a comparative analysis of 69 cases.
Dengler J, Maldaner N, Bijlenga P, Burkhardt JK, Graewe A, Guhl S, Nakamura M, Hohaus C, Kursumovic A, Schmidt NO, Schebesch KM, Wostrack M, Vajkoczy P, Mielke D; Giant Intracranial Aneurysm Study Group.
Acta Neurochir (Wien). 2015 Mar;157(3):361-8; discussion 368. doi: 10.1007/s00701-014-2292-5. Epub 2014 Dec 12.
Active bleeding from ruptured cerebral aneurysms during diagnostic angiography: emergency treatment.
Klisch J, Weyerbrock A, Spetzger U, Schumacher M.
AJNR Am J Neuroradiol. 2003 Nov-Dec;24(10):2062-5. Review. PMID: 14625234