title: Early surgical removal of migrated coil/stent after failed embolization of intracranial aneurysm.
abstract: OBJECTIVE
  Distal coil or stent migration is a rare, but potentially morbid complication of intracranial aneurysm embolization. At present, there is no established standard of surgical evacuation of displaced material-in particular, there is no consensus on the optimum time for such intervention. The authors report their positive experiences with an ultra-early surgical evacuation of 2 migrated coils and a flow-diverter stent.
  
  
  METHODS
  Uncontrolled coil or stent migration occurred in 3 (0.75%) of approximately 400 patients treated between 1999 and 2012 in the authors' institution. In all 3 cases, the materials moved from their intended position to the middle cerebral artery (MCA). Surgical evacuation was started immediately (within half an hour) after a futile attempt of removing them via intraarterial route, under the same anesthesia and with no active reversal of heparinization.
  
  
  RESULTS
  No excessive bleeding was observed. Displaced coils were extracted through an incision of a branch of MCA-the anterior temporal artery, the stent was removed through a direct incision of MCA. Recombinant tissue plasminogen activator (rtPA) was injected to the stem of the internal carotid artery toward the end of the procedure, with no discernible adverse effects. Two patients were discharged with no deficit (Glasgow Outcome Scale [GOS] Score 5); the other patient was conscious with mild hemiparesis (GOS Score 4) at discharge.
  
  
  CONCLUSIONS
  The experiences of these 3 cases suggest that immediate removal of a migrated stent/coil is feasible and may be effective. Indirect access to the MCA through its branch helps to shorten the time of temporary clipping of the artery to a minimum. Maintaining active heparinization and direct intraarterial injection of rtPA are helpful in promoting blood flow in the MCA.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Turek
authors.affiliation: Invasive Neurology.
authors.forename: Jan
authors.initials: J
authors.lastname: Kochanowicz
authors.affiliation: Radiology, and.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lewszuk
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Lyson
authors.affiliation: Neurology, Medical University of Bialystok, Poland.
authors.forename: Justyna
authors.initials: J
authors.lastname: Zielinska-Turek
authors.affiliation: Radiology, and.
authors.forename: Jan
authors.initials: J
authors.lastname: Chwiesko
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Mariak
mesh_terms: D000328:Adult; D020878:Device Removal; D061345:Early Medical Intervention; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D005548:Foreign-Body Migration / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D015607:Stents
keywords: ATA = anterior temporal artery; GOS = Glasgow Outcome Scale; ICA = internal carotid artery; ICU = intensive care unit; MCA = middle cerebral artery; PCoA = posterior commuicating artery; aneurysm embolization; cerebral aneurysm; coil migration; mRS = modified Rankin Scale; rtPA = recombinant tissue plasminogen activator; surgical evacuation; vascular disorders