Surgical extraction of migrated coils via proximal segment of the anterior cerebral artery: An emergency alternative

Coil migration is a severe complication in endovascular treatment. We report our experience of prompt surgical extraction of migrated coils via excised proximal A1 following endovascular embolization of intracranial aneurysms in two patients. Both patients had to undergo coiling or stent-assisted coiling for cerebral aneurysms, and while operating the coils protruded and migrated to the bifurcation of internal carotid artery and middle cerebral artery. Immediate craniotomy was performed after unsuccessful or unfeasible endovascular retrieval. The migrated coils were removed via excised proximal A1, and the patients recovered well without any neurological deficits. We suggest that this surgical procedure might be an alternative route in selected patients with good cross circulation in emergency. In addition, a rare occasion of coil migration after stent-assisted coiling is also described in one patient, which might have resulted from unsatisfactory wall apposition of the stent due to a curved vessel.