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AJNR - American Journal of Neuroradiology

Published ahead of print on August 21, 2008
doi: 10.3174/ajnr.A1268

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American Journal of Neuroradiology 29:1951-1955, November-December 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Stent Management of Coil Herniation in Embolization of Internal Carotid Aneurysms

C.-B. Luo^a, F.-C. Chang^a, M.M.-H. Teng^a, W.-Y. Guo^a and C.-Y. Chang^a

^a From the Department of Radiology, Taipei Veterans General Hospital and National Yang Ming University School of Medicine, Taipei, Taiwan, Republic of China

Please address correspondence to Chao-Bao Luo, MD, Department of Radiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd, Beitou, Taipei, Taiwan, Republic of China; e-mail: cbluo{at}vghtpe.gov.tw

BACKGROUND AND PURPOSE: Coil herniation into the parent artery after detachment is an uncommon complication of embolization of the intracranial aneurysm. We report our experience with stent reconstruction of the lumen and flow of the internal carotid artery (ICA) after coil herniation during embolization for intracranial ICA aneurysms and the possible mechanisms of coil herniation.

MATERIALS AND METHODS: A series of 216 consecutive patients was treated by endovascular coil embolizations for intracranial aneurysms. Of these patients, there were 9 (4 men, 5 women; 32–68 years of age) complicating with coil herniation into the ICA and undergoing stent deployment to reconstruct the ICA lumen (n = 8) or both lumen and flow (n = 1). Wide-neck aneurysms were found in 8 and narrow-neck, in 1. Aneurysms were in the posterior communicating artery (n = 5) and the paraophthalmic (n = 3) and cavernous portions (n = 1) of the ICA. Self-expandable stents were deployed in the ICA in 6; balloon-mounted stents were selected in 3.

RESULTS: The causes of coil herniation appeared to be coil instability after detachment (n = 6), excessive embolization (n = 1), microcatheter-related problems (n = 1), or being pushed by subsequent coil embolization (n = 1). Endovascular stent placement to reconstruct the lumen and/or flow of the ICA was technically successful in all 9 patients; 1 needed a second stent due to further coil migration. No significant procedure-related complications were found. Clinical follow-up was 8–35 months.

CONCLUSION: Coil herniation occasionally occurs during endovascular embolization of ICA aneurysms because of coil instability after detachment, excessive embolization, microcatheter-related problems, or pushing by subsequent coil embolization. In this small series, stent placement was safe and effective in the reconstruction of the arterial lumen and/or restoration of flow past a herniated coil mass.

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