Coil migration after endovascular coil occlusion of internal carotid artery pseudoaneurysms within the sphenoid sinus

We report two cases of coil migration after endovascular treatment of pseudoaneurysm of the internal carotid artery within the sphenoid sinus with coils and noncovered stents.

Two patients underwent sphenoid sinus exposure for pituitary adenoma and chronic infection, respectively. As a complication pseudoaneurysms of the internal carotid artery within the sphenoid sinus developed. One patient was treated with stent and coils, the second with coils alone. Both patients experienced coil migration after 9 and 26 months, respectively, with the necessity for further treatment. Imaging was performed using flat detector computed tomography (FD-CT). Literature review revealed two additional cases of coil migration and four patients with the same treatment in stable condition.

Pseudoaneurysms of the internal carotid artery are a special entity and the environment of the aneurysm within the sphenoid sinus may change over a long time. Coil embolization may lead to the late onset complication of coil migration with the possible risk of acute epistaxis. As a consequence, these patients need a careful and prolonged follow up. FD-CT is an appropriate technique to visualize the implanted coils and if present the migration of coil material.