Intracranial aneurysm coiling complications
Li J, Liu C, Liu X, Luo W, Bao K, Huang C. Efficacy and complication rate of aneurysm interventional embolization in the treatment of aneurysm subarachnoid hemorrhage. Minerva Med. 2021 Jun 18. doi: 10.23736/S0026-4806.21.07617-5. Epub ahead of print. PMID: 34142780.
Distal coil migration or stent migration is a rare, but potentially morbid complication of intracranial aneurysm embolization.
In a retrospective review, Yeon et al. examined 299 patients with 339 aneurysms, all shown to be completely occluded at 36 months on follow-up images obtained between 2011 and 2013. Medical records and radiological data acquired during the extended monitoring period (mean 74.3 ± 22.5 months) were retrieved, and the authors analyzed the incidence of (including mean annual risk) and risk factors for delayed recanalization.
A total of 5 coiled aneurysms (1.5%) occluded completely at 36 months showed recanalization (0.46% per aneurysm-year) during the long-term surveillance period (1081.9 aneurysm-years), 2 surfacing within 60 months and 3 developing thereafter. Four showed minor recanalization, with only one instance of major recanalization. The latter involved the posterior communicating artery as an apparent de novo lesion, arising at the neck of a firmly coiled sac, and was unrelated to coil compaction or growth. Additional embolization was undertaken. In a multivariate analysis, a second embolization for a recurrent aneurysm (HR = 22.088, p = 0.003) independently correlated with delayed recanalization.
Almost all coiled aneurysms (98.5%) showing complete occlusion at 36 months postembolization proved to be stable during extended observation. However, recurrent aneurysms were predisposed to delayed recanalization. Given the low probability yet seriousness of delayed recanalization and the possibility of de novo aneurysm formation, careful monitoring may be still considered in this setting but at less frequent intervals beyond 36 months 1).
Parent artery occlusion
Coil migration either during the procedure or after coil embolization.