Irretrievable unraveled coil remaining in the vascular lumen between the cerebral aneurysm and puncture site

「Abstract」Objective: Unraveled coils can be removed during cerebral aneurysm embolization. However, if the unraveled coil is engaged with other indwelling coils, its retrieval is sometimes difficult. We report 2 patients in whom unraveled coils were irretrievable, and were left in the vascular lumen between the aneurysm and the puncture site, rather than being forcibly retrieved. Methods: We stretched the unraveled coil as much as possible in the parent artery, and withdrew the catheters. The unraveled coil remained in the vascular lumen between the aneurysm and the puncture site. The tail of the unraveled coil was cut and, making a small incision at the puncture site, the remaining part was buried with ligation in the subcutaneous tissue. Systemic heparinization and antiplatelet therapy were performed after the procedure. Results: Neither patient experienced complications attributable to the unraveled coil in the vascular lumen. Coil compaction occurred in one patient who underwent further coil embolization. The residual unraveled coil was not affected by the procedure and remained stable in the vascular lumen. Conclusion: We consider that leaving the unraveled coils in the vascular lumen is an acceptable alternative to forcible retrieval.