Coil Catastrophe Averted: A Technical Note on Retrieval From the Basilar Artery

Early treatment of vertebral artery dissecting aneurysms (VADA) is associated with improved outcomes. Endovascular treatment options utilising both deconstructive and reconstructive techniques have been used. Coil migration may occur during parent vessel occlusion as a rare complication that can lead to further thromboembolic events. Various strategies for coil retrieval have been documented; however, management currently relies on the discretion of the proceduralist, as there is no established consensus on a standardised salvage technique. This technical note describes a coil embolisation parent artery occlusion for a ruptured VADA complicated by a migrated coil into the basilar artery and a salvage technique using a stent retriever and aspiration catheter. The coil mass was successfully retrieved from the basilar artery using a hybrid-cell stent retriever and a larger-bore aspiration catheter. The aneurysm was then treated with parent vessel reconstruction using a flow diverter stent. Post-operatively, ischaemic changes were noted in the left temporal lobe. At the six-month follow-up, she has a modified Rankin Scale (mRS) score of 2 and is currently participating in rehabilitation. Coil migration during endovascular parent artery sacrifice is a rare complication. In this technical note, we describe how using a hybrid-cell design stent retriever in combination with a large-bore aspiration catheter, positioned across the long axis of the coil mass, enabled successful retrieval in a single VADA case.