Intracranial stent placement to trap an extruded coil during endovascular aneurysm treatment: Technical note

OBJECTIVE: The development of low profile, navigable stents has expanded th e range of intracranial neuroendovascular procedures. We report a unique ca se of endovascular stent placement to trap a partially extruded Guglielmi d etachable coil (CDC) during treatment of an internal carotid artery (ICA) c avernous segment aneurysm. METHODS: A 49-year-old woman presented for endovascular coiling of a left s uperior hypophyseal artery aneurysm. Previously, a contralateral mirror les ion had been treated by stent-assisted coiling. Heparin was administered to maintain an activated coagulation time of greater than 250 seconds, and a guide catheter was placed in the cervical ICG A microcatheter was advanced into the aneurysm over a microguidewire. A GDC-10, 3-dimension, 6 x 20-mm c oil was placed within the aneurysm, forming a stable basket. Three addition al GDCs were placed with near-complete obliteration of the aneurysm. Attemp ted placement of a fifth coil caused partial prolapse of a previously place d coil into the cavernous lCA. We decided to place a stent rather than to s nare the extruded coil because the extruded coil was integral to the aneury sm coil mass. A 3.5 x 8-mm balloon-expandable stent was placed across the a neurysm orifice, trapping the extruded coil between the stent and ICA. RESULTS: Digital subtraction angiography documented patency of the ICA lume n. The patient remains neurologically intact and awaits 3-month follow-up c erebral angiography. CONCLUSION: Trapping of an extruded intraaneurysmal coil via stent placemen t obviated the need for coil removal and avoided the risk of coil mass mani pulation. The use of a stent to displace extruded coils and reconstitute a "normal" lumen is an excellent addition to our endovascular armamentarium.