title: Short- and intermediate-term angiographic and clinical outcomes of patients with various grades of coil protrusions following embolization of intracranial aneurysms.
abstract: OBJECTIVE
  An infrequent occurrence during endovascular treatment is protusion of detachable coils into the parent lumen with a subsequent thrombosis within in the parent vessel or embolic events. We report the short- and intermediate-term angiographic and clinical outcomes of patients who experience coil or loop protrusions and are managed with medical or additional endovascular treatments.
  
  
  METHODS
  The coil protrusions were identified by retrospective review of 256 consecutive patients treated at 3 centers with endovascular embolizations for intracranial aneurysms and subsequently categorized as grade I when a single loop or coil protruded into the parent vessel lumen less than half the parent artery diameter; grades II and III were assigned when a single coil or loop protruded more than half the parent artery diameter, respectively.
  
  
  RESULTS
  There were 19 patients with grade I (n = 9), grade II (n = 4), or grade III (n = 6) coil protrusions. Patients with active hemodynamic compromise (n = 6) had intracranial stents placed in addition to aspirin (indefinitely) and clopidogrel (range, 1-12 months; mean, 4.5 months) treatment. The remaining patients were placed on aspirin indefinitely. Complete aneurysm obliteration was achieved in all patients except in 3 in whom near-complete obliteration was achieved. Two patients had intraprocedural aneurysm ruptures, both of whom survived hospitalization. There were 4 deaths (4-21 days), all due to major strokes in different vascular distributions related to vasospasm (unrelated to the coil protrusion).
  
  
  CONCLUSIONS
  Management of coil protrusions with antiplatelet therapy and placement of stents (in selected patients) appears efficacious in preventing vessel thrombosis.
authors: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, USA.
authors: M
authors: M
authors: Abdihalim
authors: S H
authors: SH
authors: Kim
authors: A
authors: A
authors: Maud
authors: M F K
authors: MF
authors: Suri
authors: N
authors: N
authors: Tariq
authors: A I
authors: AI
authors: Qureshi
mesh_terms: D000328:Adult; D000368:Aged; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome