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           A report of intracranial aneurysmal coil rotation

Coil compaction (bunch‑up of coils) after aneurysm coiling is a well‑known phenomenon, which is associated with aneurysm recurrence and its regrowth.[1] This is especially seen in large aneurysms or end‑on aneurysms. However, we report an unusual case of asymptomatic delayed “coil rotation” within a small aneurysm of distal anterior cerebral artery.

A 60-year‑old male presented with sudden onset severe headache and vomiting followed by transient loss of consciousness. His computed tomography scan was suggestive of left paramedian frontal lobe hematoma. His initial digital subtraction angiogram (DSA) was negative; however, the follow up DSA after a month revealed a left A2 segment anterior cerebral artery aneurysm measuring 1.5 mm × 1.5 mm. He underwent coiling using a

1.5 mm × 1 cm two‑dimensional helical coil and was discharged in a stable condition. His 6 month follow‑up check angiogram did not reveal either a residual/recurrent aneurysm or coil compaction. However, the single coil, which was initially vertically oriented at the time of coiling, was now lying horizontally within the aneurysm [Figure 1]. No evidence of occlusion of the adjacent normal artery as well as the parent vessel was noted.

Figure 1: Serial digital subtraction angiogram, lateral view following right internal carotid artery injection. (a) Pretreatment digital subtraction angiogram showing a small distal anterior cerebral artery aneurysm (arrow); (b) digital subtraction angiogram image immediately after the coiling; (c) digital subtraction angiogram image during 6 months follow‑up; (d‑f) enlarged view of the aneurysm, the coil appearance immediately after coiling, and after 6 months

This phenomenon of “coil rotation” has not yet been reported in the literature; hence, its clinical significance is not known. However, the possibilities of rebleeding during or following rotation of the coil, coil migration and thromboembolic phenomenon remain clinical concerns. At the time of coiling, three‑dimensional, small‑sized coils were not available; hence, two‑dimensional helical coils were used. With the current availability of three‑dimensional, small-sized coils, theirpreference in these types of cases may be a viable option.

Harsha Jayaprakash Kamble

Department of Endovascular Neurosurgery,

Indo‑American Hospital, Brain and Spine Centre,

Chemmanakary, Vaikom ‑ 686 143,

Kerala, India.

E‑mail: kjharsha@gmail.com

Reference

1.      Sluzewski M, van Rooij WJ, Slob MJ, Bescós JO, Slump CH, Wijnalda D. Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 2004;231:653‑8.

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Kamble HJ. A report of intracranial aneurysmal coil rotation. Neurol India [serial online] 2015 [cited 2015 Aug 11];63:605-6. Available from: http://www.neurologyindia.com/text.asp?2015/63/4/605/162079