Coil migration during or after endovascular coiling of cerebral aneurysms.
Adult
Aged
Canada
/ epidemiology
Cerebral Angiography
/ methods
Endovascular Procedures
/ adverse effects
Female
Foreign-Body Migration
/ diagnostic imaging
France
/ epidemiology
Humans
Intracranial Aneurysm
/ diagnostic imaging
Male
Middle Aged
Prospective Studies
Retrospective Studies
Stents
/ adverse effects
Treatment Outcome
United States
/ epidemiology
cerebral aneurysms
coil migration
endovascular coiling
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
22
07
2019
revised:
07
10
2019
accepted:
08
10
2019
pubmed:
31
10
2019
medline:
8
9
2020
entrez:
31
10
2019
Statut:
ppublish
Résumé
Coil migration is a complication of endovascular coiling of cerebral aneurysms that has not been well studied. To report the frequency, risk factors, management strategies, and outcomes of coil migration. This was a retrospective analysis of the clinical and radiological data of patients who underwent cerebral aneurysm coiling complicated by coil migration at five neuroendovascular centers in the United States, Canada, and France between 2008 and 2018. Eighteen cases of coil migration met our study criteria with an occurrence of 0.3% (18/6071 cases) (procedural migration: 55%, delayed migration: 45%). The mean aneurysm maximal diameter, neck, and height to neck ratio in migration cases were 3.4±1.4 mm (range 2-7.6 mm), 2.4±0.9 mm (range 1.2-4.4 mm), and 1.4±0.4 (range 1-2.15), respectively. The 2 mm diameter coil was the most common (39%, range 1-2.5 mm) migrated coil. The length of the migrated coil was ≤4 cm in 95% of cases.Patients managed conservatively (5/18, 28%) did well. Thromboembolic and/or hemorrhagic complications were noted in 6/10 migration patients treated by endovascular modalities and in all migration patients who underwent surgical treatment (4/4). Three deaths occurred (3/18, 17%) related to high Hunt and Hess grade subarachnoid hemorrhage. Coil migration is an uncommon but important complication of cerebral aneurysm coiling. Small aneurysms, aspect ratio <1.6, and small coils are significant risk factors. Endovascular treatment, such as using a stent retriever, can be considered for procedural, proximal migration, and/or in cases of vessel occlusion. Delayed or distal migration should be managed conservatively.
Sections du résumé
BACKGROUND
BACKGROUND
Coil migration is a complication of endovascular coiling of cerebral aneurysms that has not been well studied.
OBJECTIVE
OBJECTIVE
To report the frequency, risk factors, management strategies, and outcomes of coil migration.
METHODS
METHODS
This was a retrospective analysis of the clinical and radiological data of patients who underwent cerebral aneurysm coiling complicated by coil migration at five neuroendovascular centers in the United States, Canada, and France between 2008 and 2018.
RESULTS
RESULTS
Eighteen cases of coil migration met our study criteria with an occurrence of 0.3% (18/6071 cases) (procedural migration: 55%, delayed migration: 45%). The mean aneurysm maximal diameter, neck, and height to neck ratio in migration cases were 3.4±1.4 mm (range 2-7.6 mm), 2.4±0.9 mm (range 1.2-4.4 mm), and 1.4±0.4 (range 1-2.15), respectively. The 2 mm diameter coil was the most common (39%, range 1-2.5 mm) migrated coil. The length of the migrated coil was ≤4 cm in 95% of cases.Patients managed conservatively (5/18, 28%) did well. Thromboembolic and/or hemorrhagic complications were noted in 6/10 migration patients treated by endovascular modalities and in all migration patients who underwent surgical treatment (4/4). Three deaths occurred (3/18, 17%) related to high Hunt and Hess grade subarachnoid hemorrhage.
CONCLUSION
CONCLUSIONS
Coil migration is an uncommon but important complication of cerebral aneurysm coiling. Small aneurysms, aspect ratio <1.6, and small coils are significant risk factors. Endovascular treatment, such as using a stent retriever, can be considered for procedural, proximal migration, and/or in cases of vessel occlusion. Delayed or distal migration should be managed conservatively.
Identifiants
pubmed: 31662464
pii: neurintsurg-2019-015278
doi: 10.1136/neurintsurg-2019-015278
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
505-511Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.