Neurointervention.  2021 Jul;16(2):171-174. 10.5469/neuroint.2020.00444.

Electrothermal Coil Detachment Failure in Flow Diverter-Assisted Coiling of a Small Blister Aneurysm: Technical Considerations and Possible Solutions

• Pickett GE
• Cora A

• KMID: 2517743
• DOI: http://doi.org/10.5469/neuroint.2020.00444

Abstract

Flow diversion stenting combined with coiling offers both immediate protection from rebleeding for ruptured aneurysms and long-term stability for wide-necked or blister aneurysms. It is particularly useful for tiny ruptured aneurysms, alleviating the concern that small coils may prolapse between the struts of conventional stents. We employed this technique in a very small, broad-based ruptured aneurysm of the internal carotid, jailing the coiling microcatheter with a Pipeline Embolization Device. However, coil detachment repeatedly failed, until we withdrew the detachment zone into the microcatheter. We suggest that if the tip of the coiling catheter is adjacent to the stent, contact between the junction zone of the coil and the high metal density of the flow diverter may prevent proper electrothermal coil detachment. Detachment can be undertaken successfully within the microcatheter, though care must be taken thereafter to fully push the detached coil tail into the aneurysm.

Keyword

Intracranial aneurysm, therapy; Endovascular procedures, instrumentation; Endovascular procedures, complications; Intraoperative complications

Figure

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  Fig. 1. (A) Diffuse subarachnoid hemorrhage with (B) evidence of diffuse intraventricular extension of hemorrhage and early hydrocephalus. (C) Initial cerebral angiogram demonstrating the wide-necked right internal carotid artery aneurysm, after which (D) the Pipeline Embolization Device (Medtronic, Irvine, CA, USA) is seen partially deployed before (E) placing the microcatheter tip within the aneurysmal sac. Final result (F) after deployment of 2 coils and full deployment of the Pipeline Embolization Device.

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