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Minim Invasive Neurosurg 2009; 52(2): 89-92
DOI: 10.1055/s-0029-1215579
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Coil Migration after Endovascular Coil Occlusion of Internal Carotid Artery Pseudoaneurysms within the Sphenoid Sinus

T. Struffert 1 , J. H. Buhk 2 , M. Buchfelder 3 , V. Rohde 4 , A. Doerfler 1 , M. Knauth 2
  • 1Department of Neuroradiology, University of Erlangen, Erlangen, Germany
  • 2Department of Neuroradiology, University of Goettingen, Goettingen, Germany
  • 3Department of Neurosurgery, University of Erlangen, Erlangen, Germany
  • 4Department of Neurosurgery, University of Goettingen, Goettingen, Germany
Further Information

Publication History

Publication Date:
18 May 2009 (online)

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Abstract

Introduction: We report two cases of coil migration after endovascular treatment of pseudoaneurysm of the internal carotid artery within the sphenoid sinus with coils and noncovered stents.

Case Reports: Two patients underwent sphenoid sinus exposure for pituitary adenoma and chronic infection, respectively. As a complication pseudoaneurysms of the internal carotid artery within the sphenoid sinus developed. One patient was treated with stent and coils, the second with coils alone. Both patients experienced coil migration after 9 and 26 months, respectively, with the necessity for further treatment. Imaging was performed using flat detector computed tomography (FD-CT). Literature review revealed two additional cases of coil migration and four patients with the same treatment in stable condition.

Conclusion: Pseudoaneurysms of the internal carotid artery are a special entity and the environment of the aneurysm within the sphenoid sinus may change over a long time. Coil embolization may lead to the late onset complication of coil migration with the possible risk of acute epistaxis. As a consequence, these patients need a careful and prolonged follow up. FD-CT is an appropriate technique to visualize the implanted coils and if present the migration of coil material.

Key words

pseudoaneurysm - coil embolization - stent - flat detector computed tomography

References

  • 1 Raymond J, Hardy J, Czepko R. et al . Arterial injuries in transsphenoidal surgery for pituitary adenoma: The role of angiography and endovascular treatment.  AJNR. 1997;  18 655-665
    PubMedGoogle Scholar
  • 2 Buerke B, Tombach B, Stoll W. et al . Magnetic resonance angiography follow-up examinations to detect iatrogenic pesudoaneurysms following otorhinolaryngological surgery.  J Laryngol Otol. 2007;  121 ((7)) 698-701
    PubMedGoogle Scholar
  • 3 Kadyrov NA, Friedman JA, Nichols DA. et al . Endovascular treatment of an internal carotid artery pseudoaneurysm following transsphenoidal surgery.  J Neurosurg. 2002;  96 624-627
    CrossrefPubMedGoogle Scholar
  • 4 Li MH, Li, YD. et al . A new covered stent designed for intracranial vasculature: application in the management of pseudoaneurysms of the cranial internal carotid artery.  AJNR. 2007;  28 1579-1585
    PubMedGoogle Scholar
  • 5 Kalender WA, Kyriakou Y. Flat-detector computed tomography (FD-CT).  Eur Radiol. 2007;  17 2767-2779
    CrossrefPubMedGoogle Scholar
  • 6 Richter G, Engelhorn T, Struffert T. et al . Flat panel detector angiographic CT for stent-assisted coil embolization of broad-based cerebral aneurysms.  AJNR Am J Neuroradiol. 2007;  28 ((10)) 1902-1908
    CrossrefPubMedGoogle Scholar
  • 7 Scholz K B, Buchfelder M, Knauth M. Coildislokation und Coilektomie nach Versorgung eines iatrogenen intrakavernösem Pseudoaneurysma der Arteria carotis interna.  RöFo. 2007;  179 ((8)) 862-863 , Article in German, no Abstract available
    PubMedGoogle Scholar
  • 8 Pozzati E, Giuliani G, Poppi M. et al . Blunt traumatic carotid dissection with delayed symptoms.  Stroke. 1989;  20 412-416
    CrossrefPubMedGoogle Scholar
  • 9 Pretre R, Kursteiner K, Reverdin A. et al . Blunt carotid artery injury: devastating consequences of undetected pseudoaaneurysm.  J Trauma. 1995;  39 1012-1014
    PubMedGoogle Scholar
  • 10 Lantos GL, Fein JM, Knep S. Cortical artery aneurysm formation after extracranial to intracranial baypass surgery. Case report.  J Neurosurg. 1984;  60 636-639
    CrossrefPubMedGoogle Scholar
  • 11 Overton  III  MC, Calvin  Jr  TH. Iatrogenic cerebral cortical aneurysms. Case report.  J Neurosurg. 1966;  24 672-675
    PubMedGoogle Scholar
  • 12 Dario A, Dorizzi A, Scamoni C. et al . Iatrogenic intracranial aneurysm. Case report and review of the literature.  J Neurosurg Sci. 1997;  41 195-202
    PubMedGoogle Scholar
  • 13 Cosgrove GR, Villemure JG, Melancon D. Traumatic intracranial aneurysm due to arterial injury at surgery. Case Report.  J Neurosurg. 1983;  58 291-294
    PubMedGoogle Scholar
  • 14 Wakai S, Yoshimasu N, Eguchi T. et al . Traumatic intracavernous aneurysm of the internal carotid artery following surgery for chronic sinusitis.  Surg Neurol. 1980;  13 391-394
    PubMedGoogle Scholar
  • 15 Eckert B, Thie A, Carvajal M. et al . Predicting hemodynamic ischemia by transcranial Doppler monitoring during therapeutic balloon occlusion of the internal carotid artery.  AJNR. 1998;  19 577-582
    PubMedGoogle Scholar
  • 16 Hattori I, Iwasaki K, Horikawa F. et al . Treatment of a ruptured giant internal carotid artery pseudoaneurysm following transsphenoidal surgery: case report and literature review.  No Shinkei Geka. 2006;  34 ((11)) 1141-1146
    PubMedGoogle Scholar
  • 17 Origitano TC, al-Mefty O, Leonetti JP. et al . Vascular considerations and complications in cranial base surgery.  Neurosurgery. 1994;  35 351-362
    PubMedGoogle Scholar
  • 18 Higashida RT, Halbach VV, Dowd C. et al . Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: Results in 87 cases.  J Neurosurg. 1990;  72 857-863
    PubMedGoogle Scholar
  • 19 Zhuang Q, Buckman CR, Harrigan MR. Coil extrusion after endovascular treatment, Case report.  J Neurosurg. 2007;  106 512
    CrossrefPubMedGoogle Scholar
  • 20 Shin YS, Kim SY, Moon SK. Intranasal extrusion of the endovascular coil after occluding internal carotid artery for massive nasopharyngeal bleeding.  Otolaryngol Head Neck Surg. 2005;  133 ((4)) 644
    PubMedGoogle Scholar
  • 21 Fontela PS, Tampieri D, Atkinson JD. et al . Posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis.  Pediatr Crit Care Med. 2006;  7 ((3)) 260-262
    CrossrefPubMedGoogle Scholar
  • 22 Van Nieuwenhove Y, Van den Brande P, van Tussenbroek F. et al . Iatrogenic carotid artery pseudoaneurysm treated by an autologous vein-covered stent.  Eur J Vasc Endovasc Surg. 1998;  16 262-265
    CrossrefPubMedGoogle Scholar
  • 23 Saatci I, Cekirge HS, Ozturk MH. et al . Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mit-term follow up results.  AJNR. 2004;  25 1742-1749
    PubMedGoogle Scholar
  • 24 Leung GK, Auyeung KM, Lui WM. et al . Emergency placement of a self-expandable covered stent for carotid artery injury during trans-sphenoidal surgery.  Br J Neurosurg. 2006;  20 ((1)) 55-57
    CrossrefPubMedGoogle Scholar
  • 25 Alexander MJ, Smith TP, Tucci DL. Treatment of an iatrogenic petrous carotid artery pseudoaneurysm with a Symbiot covered stent: technical case report.  Neurosurgery. 2002;  50 ((3)) 658-662
    CrossrefPubMedGoogle Scholar
  • 26 Ahuja V, Tefera G. Successful covered stent-graft exclusion of carotid artery pseudo-aneurysm: two case reports and review of the literature.  Ann Vasc Surg. 2007;  21 ((3)) 367-372
    CrossrefPubMedGoogle Scholar

Correspondence

T. StruffertMD 

Department of Neuroradiology

University of Erlangen

Schwabachanlage 6

91054 Erlangen

Germany

Phone: +49/9131/853 93 88

Fax: +49/9131/853 61 79

Email: tobias.struffert@uk.uni-erlangen.de