Surgical management of distal coil migration and arterial perforation after attempted coil embolization of a ruptured ophthalmic artery aneurysm: technical case report.
OBJECTIVE
Distal coil migration is a rare but hazardous complication of aneurysm coil embolization. Various microsnare devices have been developed to address this problem. We describe the surgical management of a case in which microsnare retrieval failed.


METHODS
A 34-year-old woman presented with subarachnoid hemorrhage. Magnetic resonance imaging, computed tomography angiography, and conventional angiography showed an approximately 2.5-mm ophthalmic artery aneurysm. Using balloon remodeling, a 2 x 4-cm coil was deployed into the aneurysm fundus. While the coil pusher was being removed after deployment, the microcatheter advanced abruptly into the aneurysm. The coil mass was dislodged and migrated into the angular branch of the middle cerebral artery. Contrast extravasation was noted during attempted retrieval with a microsnare device.


METHODS
Computed tomographic scans showed a subarachnoid hemorrhage in the territory of the left frontotemporal operculum. A left modified orbitozygomatic approach was performed. The coil mass was removed from the angular artery and a thromboembolectomy was performed. The artery was repaired and the pseudoaneurysm was clip ligated. The ophthalmic artery aneurysm was clip ligated. The patient recovered without deficits.


CONCLUSIONS
Distal coil migration and arterial perforation can be treated surgically with a good clinical outcome.
Division of Neurosurgical Surgery, Barrow Neurological Institute, Phoenix, Arizona 85013, USA.
Vivek R
VR
Deshmukh
Jeffrey
J
Klopfenstein
Felipe C
FC
Albuquerque
Louis J
LJ
Kim
Robert F
RF
Spetzler
D000328:Adult; D017542:Aneurysm, Ruptured / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009880:Ophthalmic Artery / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods