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|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 6 | Page : 992-995
Retrievable stent for migrated coil removal: Literature review
Xin-Pu Chen, Zheng Feng Wang, Zhai Guang, Xian-Zhi Liu
Department of Neurosurgery, The First Affiliated Hospital of Zheng Zhou University, Zheng Zhou, China
|Date of Web Publication||20-Nov-2015|
Department of Neurosurgery, The First Affiliated Hospital of Zheng Zhou University, Zheng Zhou
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chen XP, Wang ZF, Guang Z, Liu XZ. Retrievable stent for migrated coil removal: Literature review. Neurol India 2015;63:992-5
Coil migration is a serious complication that may occur during endovascular embolization of intracranial aneurysms. The salvage strategy is usually coil removal from the parent artery in order to avoid thromboembolic vessel occlusion that may lead to a permanent neurological deficit. The retrievable stent used for stent-assisted coiling in intracranial aneurysms and for thrombectomy in acute ischemic stroke, was recently found to be effective in the removal of a migrated coil. We report a case where retrievable Solitaire stent was utilized for migrated coil retrieval during endovascular coiling of an aneurysm. We review the literature describing the use of retrievable stent for migrated coil removal.
A 45-year-old female patient, presenting with chronic headache for several years, was admitted to our hospital. Computed tomography angiography showed a right-sided unruptured intracranial aneurysm in the suprasellar location. She had no known medical history or coexisting neurological disability. Results of transfemoral cerebral angiography confirmed an unruptured paraclinoid aneurysm, and coil embolization was scheduled under general anesthesia [Figure 1]. An Excelsior ® SL-10® microcatheter was placed in the aneurysm, and coiling was performed. The first coil (Microvention Cosmos 3 mm × 6 cm) was successfully introduced and detached. During the introduction of the second coil (Microvention Helical 2 mm × 4 cm), we detected the first coil loop protruding towards the parent vessel, when the detachment point was 2 mm away from the distal marker of a microcatheter [Figure 1]. To avoid the risk of coil migration, an attempt was made to withdraw the last coil; however, the initially detached coil prolapsed out from the aneurysm and migrated into the internal carotid artery [Figure 2]. We decided to retrieve the coil by using a 4 mm × 20 mm Solitaire ® stent (Ev3, Solitaire AB). During navigation of the Rebar ® 18 Microcatheter over a microwire, the coil further migrated to the internal carotid artery bifurcation [Figure 3]. To remove the migrated coil, a stent was inserted and deployed across the coil. The stent retriever and the microcatheter were then withdrawn slowly under live fluoroscopy, and the migrated coil moved in tandem with the stent [Figure 4]. We kept on repeating the above-mentioned procedure until the coil was removed out of the guiding catheter. The patient did not develop any neurological deficits and was discharged 5 days after the procedure.
|Figure 1: DSA image showing the first coil loop protruding toward the parent vessel at the time of the second coil insertion|
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|Figure 2: DSA image showing that the initially detached coil further migrated to the carotid bifurcation, caused by the Rebar 18 microcatheter|
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|Figure 3: DSA image showing stent retriever being pulled from the intracranial circulation with the coil engaged|
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|Figure 4: Postoperative image showing no evidence of vascular injury or branch occlusion|
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We report a case where retrieval of the migrated coil was performed using a Solitaire stent device. To our knowledge, this is the eighth report of coil retrieval using a stent. The concept of using a stent for migrated coil retrieval was first reported in 2008 by Wakhloo and Gounis, who used a retrievable closed-cell intracranial stent to successfully extract coil material in vivo from an aneurysm model. O'Hare et al., used this technique for the first clinical application in 2010. Leslie-Mazwi et al., presented the largest series of 14 patients with a displaced coil during aneurysm coiling, in whom the coils were completely removed by using a stent retriever system. A total of 17 patients and 5 swine models were found in 7 English references where the stent was used for displaced coil retrieval.,,,,,, We summarize their coil location, coil type, retrieval technique, and procedure-induced complications in [Table 1]. The migrated coils included HyperSoft/2 × 3, Target 360°/6 × 15, Hydroframe/3 × 6, Hydrosoft helical 2.5 × 4, Complex Standard, and Penumbra/10 × 40, respectively. They were located in the internal carotid artery, middle cerebral artery (M1 segment), anterior cerebral artery (A2/A3 segment), and basilar artery. The migrated coils were removed successfully in all the 17 patients (100%). Asymptomatic mild vasospasm of the distal pericallosal artery occurred in one patient who had an uneventful postprocedural course and was discharged in neurologically intact condition. Nikoubashman et al., presented experimental studies evaluating the role of Trevo ProVuestent retriever in swines. A total of 148 coils of various types and sizes were placed into arteries of varying diameters in 4 swines. Coil retrieval was successful in 106 (72%) of the 148 cases, and it was successful in 101 of the 102 cases (99%) where trapping of the coil within the stent occurred. After each retrieval, the vessels were examined with digital subtraction angiography. There was no case of vessel perforation, vasospasm, or occlusion.
|Table 1: Review of the previously reported cases of migrated coil removal with stent|
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Two different retrieval techniques have been described in the literature. In the standard thrombectomy technique used by O'Hare and in our case, the microcatheter is placed just beyond the coil. Then the retrievable stent is introduced into the microcatheter and advanced to the distal tip of the microcatheter. The stent is fixed in place and the microcatheter is withdrawn to partially deploy the stent. Finally, the device and the microcatheter are withdrawn to retrieve the coil. In the resheath technique, the stent retriever is partially resheathed to trap the coil within the stent struts, when the coil thread is compressed and entangles itself within the stent mesh. This technique was used successfully for migrated coil retrieval in 16 out of 17 patients and 101 out of 102 cases (99%) in the swine model. An analysis of the literature review shows that the resheath technique is more effective than the standard thrombectomy technique.
On the basis of the success of this case and a review of the available literature, it is apparent that the retrievable stent seems to be suited to remove displaced coils from intracranial vessels.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Wakhloo AK, Gounis MJ. Retrievable closed cell intracranial stent for foreign body and clot removal. Neurosurgery 2008;62 (ONSSuppl 2):ONS390-ONS4.
O'Hare AM, Rogopoulos AM, Stracke PC, Chapot RG. Retrieval of displaced coil using a Solitaire ®
stent. Clin Neuroradiol 2010;20:251-4.
Leslie-Mazwi TM, Heddier M, Nordmeyer H, Stauder M, Velasco A, Mosimann PJ, et al.
Stent retriever use for retrieval of displaced microcoils: A consecutive case series. AJNR Am J Neuroradiol 2013;34:1996-9.
Hopf-Jensen S, Hensler HM, Preiß M, Müller-Hülsbeck S. Solitaire® stent for endovascular coil retrieval. J Clin Neurosci 2013;20:884-6.
Liu KC, Ding D, Starke RM, Geraghty SR, Jensen ME. Intraprocedural retrieval of migrated coils during endovascular aneurysm treatment with the Trevo stentriever device. J Clin Neurosci 2014;21:503-6.
Kabbani MR, Smith A, Leider M. Endovascular coil retrieval using a TrevoProVue stentriever. J Neurointerv Surg 2015;7:e19.
Nikoubashman O, Pjontek R, Brockmann MA, Tolba R, Wiesmann M. Retrieval of migrated coils with stent retrievers: An animal study. AJNR Am J Neuroradiol 2015;36:1162-6.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]