Early surgical removal of migrated coil/stent after failed embolization of XXXX .

@entity1 @entity548 @entity2500 @entity1269 @entity1456 @entity438
UNASSIGNED: OBJECT Distal coil or stent migration is a rare, but potentially morbid complication of @entity438 . At present, there is no established standard of surgical evacuation of displaced material-in particular, there is no consensus on the optimum time for such intervention. The authors report their positive experiences with an ultra-early surgical evacuation of 2 migrated coils and a flow-diverter stent. METHODS Uncontrolled coil or stent migration occurred in 3 (0.75%) of approximately 400 @entity1 treated between 1999 and 2012 in the authors' institution. In all 3 cases, the materials moved from their intended position to the @entity2500 ( @entity2500 ). Surgical evacuation was started immediately (within half an hour) after a futile attempt of removing them via intraarterial route, under the same anesthesia and with no active reversal of heparinization. RESULTS No excessive @entity548 was observed. Displaced coils were extracted through an incision of a branch of @entity2500 -the anterior temporal artery, the stent was removed through a direct incision of @entity2500 . Recombinant @entity1456 (rtPA) was injected to the stem of the internal carotid artery toward the end of the procedure, with no discernible adverse effects. Two @entity1 were discharged with no deficit (Glasgow Outcome Scale [GOS] Score 5); the other @entity1 was conscious with mild @entity1269 (GOS Score 4) at discharge. CONCLUSIONS The experiences of these 3 cases suggest that immediate removal of a migrated stent/coil is feasible and may be effective. Indirect access to the @entity2500 through its branch helps to shorten the time of temporary clipping of the artery to a minimum. Maintaining active heparinization and direct intraarterial injection of rtPA are helpful in promoting blood flow in the @entity2500 .
