Mini-arteriotomy to remove misplaced Gugliemi detachable coils: case report and technical note

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Cerebrovascular Disease

Background:

• Endovascular embolization using coils is a standard treatment for intracranial aneurysms.
• Misplacement of coils can lead to thromboembolic complications, such as stroke, causing significant neurological deficits.
• Ruptured posterior communicating artery aneurysms present unique challenges in treatment and management.

Observation:

• A case of a ruptured posterior communicating artery aneurysm is presented.
• The patient experienced a thromboembolic complication due to coil misplacement in the left middle cerebral artery during embolization.
• A novel surgical approach, mini-arteriotomy, was employed for retrieval of the misplaced coil.

Findings:

• The mini-arteriotomy procedure was successful in rescuing the error embolism.
• This surgical technique provided a direct and effective method to address misplaced coils in the cerebral vasculature.
• The patient's neurological deficits were potentially mitigated by the successful retrieval of the misplaced embolic material.

Implications:

• Mini-arteriotomy may serve as a viable alternative treatment for managing coil-related thromboembolic complications after aneurysm embolization.
• This approach offers a practical solution for retrieving misplaced coils in a broad area of the cerebral vasculature.
• Further investigation into this technique could refine treatment strategies for complex cerebrovascular cases.