Rescue microsurgery in coil herniation causing thromboembolic occlusion of parent artery

Malpositioned coils can provoke abrupt occlusion of the parent vessels and/or neighboring branches causing stroke during coil embolization (CE) of intracranial aneurysms. The authors describe a series of cases in which urgent surgical recanalization of the vessels clogged with herniated or migrated coils rescued the patients. A total of six patients with aneurysms who underwent surgical management for parent artery occlusion linked with inadvertent coil herniation were selected. Their medical-surgical records and operative video recordings were reviewed retrospectively. There were five females and one male whose ages ranged from 44 to 59 years. Occluded vessels associated with CE were three A2 segments of the anterior cerebral artery (ACA), two M2 segments of the middle cerebral artery (MCA) and one superior cerebellar artery (SCA). Surgical management included securing control of both the proximal and distal parent artery, making small openings, safe removal of coils, thorough cleaning of debris and thrombus, and subsequent closure of the opening, which was successful in five of patients and resulted in excellent clinical outcome. However, in the SCA case, surgical retrieval of coils failed due to technical difficulties and yielded untoward results. This report demonstrates that timely surgical intervention could be considered as a safe and effective option to solve serious thromboembolic complications of CE associated with herniated coils.