Abstract 1122‐000164: Peri‐embolization Use of Stent Retrievers as a Rescue Tool in Patients with Subarachnoid Hemorrhage

Abstract

Introduction: Coil migration after endovascular embolization of intracranial aneurysms is one of the periprocedural complications in 2–6% of patients. Stent retriever use is well‐established in treatment of ischemic stroke but has not been well established to address coil retrieval as rescue therapy. We describe three cases with successful removal of migrated coils using stent retrievers. Methods: A retrospective review at a single center university hospital was performed for all Neuro‐endovascular case log from December 2018 to November 2020. Cases of coil migration were reviewed and coil retraction with Stent Retriever with successful coil mass extraction was considered an endpoint. Number of attempts, types of stent retrievers used and time taken for extraction were noted. Results: Case 1: 56‐year‐old female presented with ruptured tri‐lobed 4 × 3 mm Anterior communicating artery aneurysm. Hunt and Hess (H&H) Grade 2. Modified Fisher scale (MFS) 4. Underwent primary coil embolization. Two 2mmx2cm Galaxy Orbit coils were deployed within aneurysm. During deployment of third coil the first two coils displaced out of the aneurysm migrating into left A2 segment. Stryker’s Trevo 3 × 20 mm stent retriever was used for retrieval of coils however they dislodged at the left internal carotid artery (ICA) terminus and migrated distally into the left middle cerebral artery (MCA) M2 superior division. Subsequently, Medtronic’s Solitaire 4 × 40 mm stent retriever was successfully deployed retrieving the migrated coils with full recanalization. Case 2: 64‐year‐old female presented with ruptured 3 × 5.3 mm right posterior communicating artery (Pcom) aneurysm. H&H 5 and MFS 4. Underwent primary coil embolization with placement of Galaxy Orbit 2.5mmx3.5cm coil. On follow up run, coil mass had migrated into the origin of right fetal Pcom. Migrated coil was successfully retrieved using Stryker’s 4 × 40 mm stent retriever with complete recanalization. Case 3: 65‐year‐old female with presented ruptured 8.5 × 6.8 mm right supraclinoid ICA irregular aneurysm. H&H Grade 1. MFS 3. Underwent primary coil embolization with one Galaxy coil (5mm x 10cm) with plan for future flow diversion. Two weeks later, patient experienced acute neurological worsening with new left sided hemiparesis and right gaze deviation. Imaging revealed acute occlusion of right middle cerebral artery M1 segment occlusion with thrombosed migrated coil. Patient underwent retrieval of the coil and superimposed thrombus utilizing Stryker’s Trevo (4*30 mm) stent retriever with resultant full recanalization. Conclusions: These cases demonstrate successful endovascular mechanical removal of migrated coils using stent retrievers. They add to the limited experience of stent retrievers utilization as effective tools for dealing with such complications.

Keywords

• Aneurysm Embolization
• Coiling
• SAH