Intracranial stent placement to trap an extruded coil during endovascular aneurysm treatment: technical note

The development of low profile, navigable stents has expanded the range of intracranial neuroendovascular procedures. We report a unique case of endovascular stent placement to trap a partially extruded Guglielmi detachable coil (GDC) during treatment of an internal carotid artery (ICA) cavernous segment aneurysm.

A 49-year-old woman presented for endovascular coiling of a left superior hypophyseal artery aneurysm. Previously, a contralateral mirror lesion had been treated by stent-assisted coiling. Heparin was administered to maintain an activated coagulation time of greater than 250 seconds, and a guide catheter was placed in the cervical ICA. A microcatheter was advanced into the aneurysm over a microguidewire. A GDC-10, 3-dimension, 6 x 20-mm coil was placed within the aneurysm, forming a stable basket. Three additional GDCs were placed with near-complete obliteration of the aneurysm. Attempted placement of a fifth coil caused partial prolapse of a previously placed coil into the cavernous ICA. We decided to place a stent rather than to snare the extruded coil because the extruded coil was integral to the aneurysm coil mass. A 3.5x8-mm balloon-expandable stent was placed across the aneurysm orifice, trapping the extruded coil between the stent and ICA.

Digital subtraction angiography documented patency of the ICA lumen. The patient remains neurologically intact and awaits 3-month follow-up cerebral angiography.

Trapping of an extruded intraaneurysmal coil via stent placement obviated the need for coil removal and avoided the risk of coil mass manipulation. The use of a stent to displace extruded coils and reconstitute a "normal" lumen is an excellent addition to our endovascular armamentarium.