Coil Catastrophe Averted: A Technical Note on Retrieval From the Basilar Artery

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Vertebral artery dissecting aneurysms (VADA) require prompt endovascular treatment for better outcomes.
• Endovascular techniques include deconstructive and reconstructive methods.
• Coil migration is a rare but serious complication during parent vessel occlusion, potentially causing thromboembolic events.

Purpose of the Study:

• To describe a novel salvage technique for managing coil migration during endovascular treatment of ruptured VADA.
• To present a case of successful coil retrieval from the basilar artery using a stent retriever and aspiration catheter.

Main Methods:

• A ruptured VADA was treated with coil embolisation and parent artery occlusion.
• A coil migrated into the basilar artery, necessitating a salvage retrieval procedure.
• A hybrid-cell stent retriever and a large-bore aspiration catheter were used for coil retrieval.
• The aneurysm was subsequently treated with parent vessel reconstruction using a flow diverter stent.

Main Results:

• Successful retrieval of the migrated coil mass from the basilar artery was achieved.
• The VADA was successfully treated with a flow diverter stent.
• Post-operative ischaemic changes were noted in the left temporal lobe.
• At six months, the patient had a modified Rankin Scale score of 2 and was undergoing rehabilitation.

Conclusions:

• Coil migration during endovascular parent artery sacrifice is a rare complication.
• A hybrid-cell stent retriever combined with a large-bore aspiration catheter offers an effective salvage strategy for coil retrieval.
• This technique facilitated successful retrieval in a challenging VADA case.