Retrieval of Migrated Coils with Stent Retrievers: An Animal Study

BACKGROUND AND PURPOSE:Coil migration is a potentially serious complication of endovascular aneurysm treatment. The aim of the study was to systematically investigate the effectiveness of coil retrieval with a stent retriever in an animal model.MATERIALS AND METHODS:A total of 148 coils of various types and sizes were placed into arteries of varying diameters in a porcine in vivo model. Coil retrieval was performed by placing a Trevo ProVue stent retriever over the coil and trying to trap a part of the platinum coil within the stent mesh by advancing the microcatheter over the stent or simply by retrieving the stent without trying to trap the coil by advancing the microcatheter.RESULTS:Coil retrieval was successful in 101 of 102 cases (99%), in which trapping of the coil within the stent retriever by advancing the microcathter was applied. When we only pulled back the stent without trapping the coil, retrieval was successful in only 5 of 46 cases (11%). Coil type, coil structure (2D versus 3D), actual coil shape in the affected vessel, investigator experience, aspiration, coil localization, and vessel diameter had no significant influence on retrieval outcome. There was no case of vessel perforation.CONCLUSIONS:Retrieval of migrated platinum coils with a stent retriever is an effective treatment option for migrated coils when the correct technique is applied.

Brain aneurysms are the most common cause of severe and potentially lethal subarachnoid hemorrhage. Endovascular treatment with detachable coils has become a common option for both ruptured and unruptured cerebral aneurysms, especially if surgery is challenging.^1–4 Coil migration is a potentially serious complication of endovascular treatment that has been reported in up to 2%–6% of cases.^5,6 Various rescue devices have been suggested for retrieval of migrated platinum coils. However, data in the literature dealing with the effectiveness and complication rates of the respective methods are restricted to a few case reports and small case series.^5–7 Our aim was to systematically investigate the effectiveness and complication rates of coil retrieval with a stent retriever in an animal model.     

Percutaneous Endoscopic Retrieval and Replacement of a Knitted (Ultraflex) Biliary Stent

A knitted (Ultraflex) biliary stent became obstructed after 5 months causing recurrent jaundice in a 92-year-old man with pancreatic cancer. The obstructed stent was successfully removed percutaneously by retrieval forceps under guidance by an 8.4 Fr fiberoptic biliary endoscope. A new stent was placed. No complications were encountered. Received: 0/00/00/Accepted: 0/00/00     

A Migrated Aortic Stent Graft Causing Erosive Spondylopathy

We report about a patient presenting with back pain 4 months after an uneventful endovascular implantation of an aortic stent graft. Computed tomography scan revealed a migration of the stent with consecutive endoleakage, kink formation, and movement of the stent toward the spine, which caused destruction of the aortic wall as well as vertebral necrosis. Explantation of the stent and replacement of the native aorta relieved the patient of his symptoms.     

Retrieval of Migrated Colonic Stents from the Rectum

Palliative stenting of malignant colonic obstruction may be complicated by stent migration. Stents that migrate into the rectum cannot be passed with bowel movements and frequently cause obstruction. We present two simple means to retrieve stents from the rectum using fluoroscopic guidance. These techniques were used successfully without complication in four stent migrations. Received: 0/00/00/Accepted: 0/00/00     

Successful Coronary Stent Retrieval From a Pedal Artery

The purpose of this article is to report complications from a coronary drug-eluting stent lost in the peripheral circulation. We report the case of successful retrieval of a sirolimus coronary stent from a pedal artery in a young patient who underwent coronary angiography for previous anterior myocardial infarction. Recognition of stent embolization requires adequate removal of the device to avoid unwelcome clinical sequelae.     

Percutaneous Endoluminal Bypass of Iliac Aneurysms with a Covered Stent

To evaluate the feasibility of percutaneous treatment of iliac aneurysms, a covered stent was inserted in nine men suffering from common iliac artery aneurysms (six cases), external iliac aneurysms (one case), or pseudoaneurysms (two cases). Placement of the stent was successful in all patients. In one patient, an endoprosthesis thrombosed after 15 days, but was successfully treated by thrombolysis and additional stent placement. At the follow-up examinations (mean period 22 months) all stent-grafts had remained patent. No late leakage or stenosis was observed.     

Percutaneous Retrieval of Chronic Intravascular Foreign Bodies

To evaluate the feasibility of intravascular retrieval of chronic foreign bodies, we retrospectively reviewed an 8 year experience (1993–2001) of percutaneous retrieval of chronically retained intravascular foreign bodies (n = 6). In 6 of 6 cases (4 catheter fragments, 2 guidewires), 5–90 days elapsed before retrieval via the femoral or internal jugular vein. Under fluoroscopy, we determined the foreign bodys course, position and size. A guidewire was advanced through a multipurpose catheter to the foreign body. The multipurpose catheter was replaced with a gooseneck snare catheter and the snare advanced to grasp and remove the foreign body. Percutaneous retrieval was successful in all 6 cases. One patient experienced mild hemoptysis, which resolved within 24 hr of observation. No patient experienced long-term sequelae. Given the potential life-threatening complications from intravascular foreign bodies and the low complication rate from percutaneous retrieval, we recommend extraction of the foreign body even if it is asymptomatic in the chronic setting (> 24 hr).     

Primary and Secondary Percutaneous Ureteral Stent Placement: Comparison of Stent Patency and Clinical Outcome

CardioVascular and Interventional Radiology - To compare early double J ureteral stent (DJUS) dysfunction rate and long-term patency between two percutaneous ureteral stent placement methods:...     

Percutaneous Retrieval of a Pulmonary Artery Catheter Knot in Pacing Electrodes

To illustrate a successful approach to resolving a pulmonary artery catheter knot in the pacing leads of a cardiac resynchronization device. When planning invasive monitoring for patients having right chamber electrodes, fluoroscopic-guided catheter insertion and extraction is advisable. In the event of coiling or knotting, an interventional radiologist should be contacted as soon as possible to avoid serious complications.     

Migrated herniated disc mimicking a neoplasm

Disc sequestration is defined as migration of a herniated disc fragment into the epidural space such that it is completely separated from the parent disc. We report a case of a migrated herniated disc that was initially pathologically diagnosed as a cartilage neoplasm. In addition to confounding morphological features, this interpretation may have been influenced by an initial radiological interpretation that did not include herniated disc in the differential diagnosis of a spinal lesion with prominent peripheral contrast enhancement. MR imaging is most helpful in considering other lesions in the differential diagnosis including abscess, hematoma, and primary or metastatic neoplasms. Pathologically, degenerative changes in herniated discs, including clustering of chondrocytes and neovascularization, may be severe resulting in a pseudoneoplastic appearance. Increased awareness of the radiological and pathological features of migrated herniated disc should limit confusion with other tumors.