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Chihara H, Maki Y, Hatano T. Unexpected coil mass migration during transvenous embolization of a dural arteriovenous fistula resolved with guidewire-assisted snaring technique. Neuroradiol J 2024:19714009241247461. [PMID: 38621829 DOI: 10.1177/19714009241247461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Endovascular embolization is a standard treatment for dural arteriovenous fistulas (dAVFs). Although it is considered relatively safe, intraoperative and postoperative complications can occur. Herein, a rare case of unexpected coil mass migration requiring a retrieval procedure during sinus occlusion for a transverse-sigmoid sinus dAVF (TSdAVF) is described. An 83-year-old man presented with worsening decline in cognitive function. Magnetic resonance angiography showed a TSdAVF. Since his symptoms seemed to be a result of the TSdAVF, transvenous embolization preserving the normal cranial venous circulation was planned. During sinus occlusion, including embolization of the shunted pouch of the TSdAVF, unexpected migration of the coil mass to the confluence of the superior sagittal sinus and the transverse sinus occurred. The migrated coil mass impeded venous circulation in the superior sagittal sinus. Since the presence of the coil mass at the confluence could have had catastrophic sequelae, the coil mass was retrieved using a guidewire-assisted snaring technique. Sinus occlusion was subsequently completed with repositioning of the coil mass at the target site. The TSdAVF resolved, with no recurrence confirmed for 1 year. Clinicians should be aware that coil mass migration can unexpectedly occur during sinus occlusion performed for treatment of a TSdAVF. The guidewire-assisted snaring technique might be effective in resolving this intraoperative complication.
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Affiliation(s)
- Hideo Chihara
- Department of Neurosurgery, Hikone Municipal Hospital, Japan
| | | | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Japan
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Kulhari A, Fourcand F, Singh A, Zacharatos H, Mehta S, Kirmani JF. Retrieval of Migrated Coils From Distal Cerebral Vasculature Using Stent Retriever: A Case Series. Cureus 2023; 15:e37213. [PMID: 37159773 PMCID: PMC10163925 DOI: 10.7759/cureus.37213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/11/2023] Open
Abstract
The incidence of coil dislocation during an endovascular embolization of intracranial aneurysm is low but it can lead to serious thrombo-embolic complications. Therefore, coil displacement/migration often requires either retrieval or fixation of the errant coil with a stent. There are no standard recommended methods of coil retrieval. We present a series of three cases in which off-label application of a stent retriever allowed successful retrieval of herniated coils.
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Affiliation(s)
- Ashish Kulhari
- Department of Neurology, Research Medical Center, Kansas City, USA
- Department of Neurology, University of Missouri Kansas City School of Medicine, Kansas City, USA
- Department of Medicine, Kansas City University of Medicine and Biosciences, Kansas City, USA
| | - Farah Fourcand
- Department of Neurology, Hackensack Meridian JFK University Medical Center, Edison, USA
| | - Amrinder Singh
- Department of Neurology, United Health Services (UHS) Binghamton General Hospital, Johnson City, USA
| | - Haralabos Zacharatos
- Department of Neurology, Hackensack Meridian JFK University Medical Center, Edison, USA
| | - Siddhart Mehta
- Department of Neurology, Hackensack Meridian JFK University Medical Center, Edison, USA
| | - Jawad F Kirmani
- Department of Neurology, Hackensack Meridian JFK University Medical Center, Edison, USA
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So C, Suzuki M, Iwaki Y, Sugiura Y, Suzuki Y, Terayama Y, Iikura M, Izumi S, Hojo M, Sugiyama H. Unexpected Complications 25 Years after Coil Embolization for Pulmonary Arteriovenous Fistula. Intern Med 2022; 62:1521-1525. [PMID: 36198600 DOI: 10.2169/internalmedicine.0560-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
An 87-year-old woman who had undergone coil embolization 25 years ago for pulmonary arteriovenous fistula, which was diagnosed following repeated cerebral infarction, presented with massive hemoptysis. The coils migrated and were excreted in stool following hemoptysis during long-term follow-up. Although the technical success rate of coil embolization for pulmonary arteriovenous malformations is extremely high, and coil embolization-related complications are rare, little is known about the long-term complications. We herein report the clinical course of our case, review previous reports related to coil migration as a long-term complication, and discuss the associated mechanism.
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Affiliation(s)
- Clara So
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yoshinobu Iwaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuriko Sugiura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yudai Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuriko Terayama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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Naga Y, Jayaraj M, Elmofti Y, Hong A, Ohning G. Intraluminal Endovascular Coil Migration: A Rare Complication Post-Embolization of the Gastroduodenal Artery for a Previously Bleeding Duodenal Ulcer. Cureus 2021; 13:e14615. [PMID: 34040915 PMCID: PMC8139854 DOI: 10.7759/cureus.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transarterial angiographic embolization is a highly effective, safe treatment for non-variceal upper gastrointestinal bleeding refractory to endoscopic intervention. However, intraluminal coil migration is a possible complication. Coil migration, while usually a self-limiting process, can lead to significant rebleeding. In our case, a patient presented with a life-threatening duodenal ulcer hemorrhage, likely precipitated by intraluminal endovascular coil migration after a recent gastro-duodenal artery embolization. He was successfully managed without endoscopic coil removal and had no additional gastrointestinal bleeding. It is important for endoscopists to be aware of this complication and weigh the risks and benefits of coil removal.
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Affiliation(s)
- Yassin Naga
- Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Mahendran Jayaraj
- Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Yousif Elmofti
- Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Annie Hong
- Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Gordon Ohning
- Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
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Hansen DM, Dyke C. Pulmonary Artery-Tracheal Fistula After Coil Implantation for Behcet's Disease. Cureus 2020; 12:e11036. [PMID: 33214963 PMCID: PMC7673279 DOI: 10.7759/cureus.11036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Behcet’s disease (BD) is a rare autoimmune disorder that results in diffuse full-thickness vasculitis. Pulmonary artery aneurysms (PAAs) and hemoptysis are known complications of this disease process, with high morbidity and mortality for affected patients. Although medical, endovascular, and surgical treatment strategies have all been described in the literature, there are little data to describe the long-term outcomes of these various treatment modalities and there continues to be a lack of clearly defined algorithms for the management of these patients. We report a case of PAA in the setting of BD who was treated over the course of many years with medical therapy and coil embolization but ultimately failed treatment, sustained a complication of coil erosion and migration into the trachea twice, and required surgical lobectomy for definitive management. We discuss an algorithm for the management of patients with BD who have PAAs.
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Affiliation(s)
- Dwayne M Hansen
- Surgery, University of North Dakota, Grand Forks, USA.,Cardiothoracic Surgery, Sanford Medical Center, Fargo, USA
| | - Cornelius Dyke
- Cardiothoracic Surgery, Sanford Medical Center, Fargo, USA
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Stanzani R, Yamada Y, Kawase T, Devareddy G, Kadam C, Shukurov F, Vaibhav C, Kato Y. Acute Coils Migration Causing Significant M3 Branch Occlusion: A Case Report of Rescue Surgery with Superficial Temporal Artery-Middle Cerebral Artery Bypass. Asian J Neurosurg 2020; 15:428-430. [PMID: 32656147 PMCID: PMC7335151 DOI: 10.4103/ajns.ajns_349_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/03/2020] [Accepted: 04/09/2020] [Indexed: 11/17/2022] Open
Abstract
We describe an uncommon case of acute coils migration with significant occlusion of M3 branch and our management of this complication. Ballon-assisted coil placement was performed for an unruptured intracavernous internal carotid artery aneurysm in a 62-year-old woman. After coil placement and balloon deflection, we observed coils migration with significant occlusion of M3 branch. After early clinical deterioration without other neurological symptoms, we decided to perform superficial temporal artery-middle cerebral artery (STA-MCA) bypass to ensure blood flow distal to the occlusion. The patient was discharged without neurological deficit. To the best of our knowledge, this is the first case report about STA-MCA bypass to treat acute coils migration. This technique could represent a successful rescue therapy in case of acute coils migration that cannot be retrieved by endovascular tools or in case where distal and deep location of migrated coils controindicate surgical removal.
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Affiliation(s)
- Riccardo Stanzani
- Department of Neurosurgery, Neurosurgery Unit AOU Policlinico di Modena - OCSAE Modena Hospital, Modena, Italy.,Department of Neurosurgery, Neurosurgical Residency Program, University of Padua, Padua, Italy.,Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Tukasa Kawase
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Gowtham Devareddy
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Chandratej Kadam
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Firuz Shukurov
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Chavan Vaibhav
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan.,Department of Neurosurgery, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Yoko Kato
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
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Abdalkader M, Piotin M, Chen M, Ortega-Gutierrez S, Samaniego E, Weill A, Norbash AM, Nguyen TN. Coil migration during or after endovascular coiling of cerebral aneurysms. J Neurointerv Surg 2019; 12:505-511. [PMID: 31662464 DOI: 10.1136/neurintsurg-2019-015278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Coil migration is a complication of endovascular coiling of cerebral aneurysms that has not been well studied. OBJECTIVE To report the frequency, risk factors, management strategies, and outcomes of coil migration. METHODS This was a retrospective analysis of the clinical and radiological data of patients who underwent cerebral aneurysm coiling complicated by coil migration at five neuroendovascular centers in the United States, Canada, and France between 2008 and 2018. RESULTS Eighteen cases of coil migration met our study criteria with an occurrence of 0.3% (18/6071 cases) (procedural migration: 55%, delayed migration: 45%). The mean aneurysm maximal diameter, neck, and height to neck ratio in migration cases were 3.4±1.4 mm (range 2-7.6 mm), 2.4±0.9 mm (range 1.2-4.4 mm), and 1.4±0.4 (range 1-2.15), respectively. The 2 mm diameter coil was the most common (39%, range 1-2.5 mm) migrated coil. The length of the migrated coil was ≤4 cm in 95% of cases.Patients managed conservatively (5/18, 28%) did well. Thromboembolic and/or hemorrhagic complications were noted in 6/10 migration patients treated by endovascular modalities and in all migration patients who underwent surgical treatment (4/4). Three deaths occurred (3/18, 17%) related to high Hunt and Hess grade subarachnoid hemorrhage. CONCLUSION Coil migration is an uncommon but important complication of cerebral aneurysm coiling. Small aneurysms, aspect ratio <1.6, and small coils are significant risk factors. Endovascular treatment, such as using a stent retriever, can be considered for procedural, proximal migration, and/or in cases of vessel occlusion. Delayed or distal migration should be managed conservatively.
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Affiliation(s)
- Mohamad Abdalkader
- Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Edgar Samaniego
- Neurology, Radiology and Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Alain Weill
- Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | | | - Thanh N Nguyen
- Neurology, Radiology and Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA
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Xu J, Zhan H, Li F, Hu S, Wang L. Coils migrate into the biliary-jejunum anastomosis: A case report. Medicine (Baltimore) 2019; 98:e13640. [PMID: 30732121 PMCID: PMC6380664 DOI: 10.1097/md.0000000000013640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Coils migration following endovascular treatment of arterial bleeding is rare. There was no clear route to deal with this complication. PATIENT CONCERNS A 55-year-old woman underwent choledochal cyst excision with hepaticojejunostomy. At the 18th day after operation, intra-abdominal hemorrhage occurred. Angiography showed active bleeding of 1 branch of the right hepatic artery and the gastroduodenal artery. That was treated by micro-coils embolization. 122 days after embolization, the patient was readmitted for chills, fever with temperature of 40°C, and jaundice. DIAGNOSIS Obstructive cholangitis. INTERVENTIONS Endoscopy was performed, which showed the micro-coils were embedded in biliary-jejunum anastomosis. Biliary sludges were adherent around micro-coils that were considered the cause of obstructive jaundice, which were washed by endoscopy. OUTCOMES Two days later endoscopy therapy, the total bilirubin (TBIL) was decreased to 58.7 μmol/L, and the patient was discharged. After 2 months of follow-up, the level of TBIL was in normal range. LESSONS Coils migration following endovascular treatment of arterial bleeding is rare. For cases with coils migrated into the biliary tract, further treatment is often needed because of the secondary cholangitis or stones. Endoscopy might be useful to deal with this intractable problem.
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Umehara T, Aoki M, Kamimura G, Wakida K, Nagata T, Otsuka T, Sato M. Coil Intrabronchial Migration in an Arteriovenous Malformation Patient Treated 10 Years Ago. Ann Thorac Cardiovasc Surg 2017; 23:200-202. [PMID: 28450683 DOI: 10.5761/atcs.cr.16-00250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 56-year-old male who had received transcatheter coil deposition 10 years ago for an arteriovenous malformation (AVM) was admitted to our hospital because of persistent hemosputum. Chest radiograph and bronchoscopy revealed straightened coil bundles in his air way. Recently, less invasive transcatheter intervention has been performed more frequently for treatment of AVM than surgical resection. In our case, however, chest radiography and bronchoscopy showed that the coils might migrate from the deposited site to the airway. Then, right lower lobectomy was undertaken. In AVM patient who received coil deposition, a long-term follow-up is recommended, and surgical resection should be carried out if necessary.
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Affiliation(s)
- Tadashi Umehara
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Masaya Aoki
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Go Kamimura
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Kazuhiro Wakida
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Toshiyuki Nagata
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Tsunayuki Otsuka
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Masami Sato
- Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
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Turek G, Kochanowicz J, Lewszuk A, Lyson T, Zielinska-Turek J, Chwiesko J, Mariak Z. Early surgical removal of migrated coil/stent after failed embolization of intracranial aneurysm. J Neurosurg 2015; 123:841-7. [PMID: 26230470 DOI: 10.3171/2015.1.jns132788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Distal coil or stent migration is a rare, but potentially morbid complication of intracranial aneurysm embolization. At present, there is no established standard of surgical evacuation of displaced material-in particular, there is no consensus on the optimum time for such intervention. The authors report their positive experiences with an ultra-early surgical evacuation of 2 migrated coils and a flow-diverter stent. METHODS Uncontrolled coil or stent migration occurred in 3 (0.75%) of approximately 400 patients treated between 1999 and 2012 in the authors' institution. In all 3 cases, the materials moved from their intended position to the middle cerebral artery (MCA). Surgical evacuation was started immediately (within half an hour) after a futile attempt of removing them via intraarterial route, under the same anesthesia and with no active reversal of heparinization. RESULTS No excessive bleeding was observed. Displaced coils were extracted through an incision of a branch of MCA-the anterior temporal artery, the stent was removed through a direct incision of MCA. Recombinant tissue plasminogen activator (rtPA) was injected to the stem of the internal carotid artery toward the end of the procedure, with no discernible adverse effects. Two patients were discharged with no deficit (Glasgow Outcome Scale [GOS] Score 5); the other patient was conscious with mild hemiparesis (GOS Score 4) at discharge. CONCLUSIONS The experiences of these 3 cases suggest that immediate removal of a migrated stent/coil is feasible and may be effective. Indirect access to the MCA through its branch helps to shorten the time of temporary clipping of the artery to a minimum. Maintaining active heparinization and direct intraarterial injection of rtPA are helpful in promoting blood flow in the MCA.
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