Retrieval of Distally Migrated Coil with Direct Aspiration Technique During Temporary Bridging Device Embolization of a Wide-Neck Supraophthalmic Aneurysm.

Background: Dislodgement of coils during endovascular embolization of brain aneurysms is a potentially hazardous complication due to high risk for cerebral infarct and subsequent neurologic deficits or death. We describe a case of whole coil mesh dislodgement due to interaction between the coil loops and a temporary neck-bridging device struts and subsequent successful retrieval of a distally migrated coil into the left middle cerebral artery branch with direct aspiration technique.

Case Description: A 32-year-old man was referred to our hospital for treatment of an unruptured wide-neck supraophthalmic aneurysm of the left internal carotid artery. A temporary bridging-neck device was placed and expanded across the aneurysm neck in order to support coil deployment inside the aneurysm sac and avoid coil prolapse into the lumen of the parent vessel. Retrieval of the bridging-neck device after coil embolization resulted in whole coil mesh dislodgement due to interaction between the coil loops and the device struts and finally distal migration of a single coil into the left middle cerebral artery temporal branch. The coil was successfully retrieved using direct aspiration technique similar to thrombectomy in acute ischemic stroke. The patient did not have any neurologic deficit.

Conclusions: Our case indicates that first-line direct aspiration technique is an atraumatic and effective procedure for coil retrieval when dislodged even in distal cerebral vessels, minimizing the chance for additional retrieval technique-related risks. Interventionists should be aware of coil dislodgment as a potential temporary bridging-neck device related complication.