PMC3362840_01
(a) and (b) Left carotid artery injection, lateral view; and plain X-ray. The stent was placed across the aneurysm neck and initial coil embolization performed. (c)-(f) During further coil embolization, the coil detached from the delivery catheter without activating the release mechanism. Manipulation and attempts to retrieve the misplaced coil with the Alligator and Microsnare device resulted in further coil herniation. (g) and (h) Left carotid artery injection, lateral view, and plain X-ray demonstrate that the misplaced coil was removed by the Merci device; a small fragment is left in the cavernous ICA and jailed to the wall with a second stent. (i) and (j) Angiogram and plain X-ray obtained after endovascular treatment show normal filling of the ICA and aneurysm occlusion.
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fig1
Aliso Viejo, CA, USA) through an Excelsior SL 10 microcatheter (Boston Scientific, Natick, MA, USA) positioned within the aneurysm dome (Figures 1(a) and 1(b)). A Hydrosoft 10 helical 4 x 6 mm coil (MicroVention, Aliso Viejo, CA, USA) was then chosen to continue the embolization. A long portion of the coil was left in the cavernous internal carotid artery (ICA) proximal to the aneurysm (Figures 1(c) and 1(d)). An Amplatz 4 mm GooseNeck Microsnare (ev3 Endovascular, Inc, Plymouth, MN, USA) was then used for retrieval, but this resulted in further coils prolapse (Figures 1(e) and 1(f)). At this point the ICA developed significant vasospasm. A remaining coil fragment was jailed to the vessel wall by placement of another Neuroform 3 stent (Figures 1(g) and 1(h)). Flow in the ICA and its branches were normal (Figures 1(i) and 1(j)).
PMC3362840_02
(a) Noncontrast head CT demonstrates diffuse SAH. (b) A lateral view of the right ICA arteriogram reveals a wide-necked PCOM aneurysm. (c) Right ICA injection angiogram at the working angle demonstrates partial coil prolapse following initial stent-assisted coiling. (d) Attempts to place an overlapping stent to hold the prolapsed coil in place resulted in anterior migration of the stent and complete coil herniation. (e) and (f) Lateral roadmap angiograms demonstrate sequential retrieval of the stent and coil mass. (g) and (h) After complete removal of the migrated stent and coils, a repeated attempt at stent-assisted coiling of the ruptured aneurysm is successful. A working view of left ICA angiogram and plain X-ray demonstrate final placement of the stent and coil.
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fig2
Digital subtraction angiography revealed a 2.5 mm right posterior communicating artery (PCOM) aneurysm with irregular dome (Figures 2(a) and 2(b)). During coiling embolization several loops of the coil bulged into the parent artery (Figures 2(c) and 2(d)). Scientific, Natick, MA, USA) led by a Synchro 2 soft microwire was advanced into the vasculature. Significant migration of the previously placed stent was noted when the microcatheter and microwire passed through the Enterprise stent and the coil mass herniated out of the aneurysm (Figures 2(e) and 2(f)). A control angiogram after final coil deployment shows obliteration of the aneurysm (Figures 2(g) and 2(h)).
PMC3362840_03
(a) Lateral view of left carotid injection demonstrates recanalization of the previously coiled ACOM aneurysm. (b) Nonsubtracted angiogram at the working view shows the dislodged coil in the left A2 segment. (c) Superselective injection demonstrates that no distal flow passes the migrated coil. (d) Plain X-ray demonstrating the Merci device passing the coil obstruction. (e) The Merci device ensnares the migrated coil. (f) Postretrieval angiogram shows reconstitution of distal left A2 flow.
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fig3
A 68-year-old man presented in 2010 with recanalization of a previously treated anterior communicating artery (ACOM) aneurysm (Figure 3(a)). A2 segment of the anterior cerebral artery (Figure 3(b)). A repeated injection demonstrates thrombosis of the left A2 without flow distal to the migrated coil (Figure 3(c)). At this point the SSEP signals were lost from the right leg. The catheter was then taken distal to the coil, and a V2.0 soft Merci retriever was deployed and successfully ensnared the migrated coil (Figures 3(d) and 3(e)). A2 (Figure 3(f)). At this point the SSEP signals returned to normal.