Delayed coil migration after stent assisted coiling of a previously WEB (Woven EndoBridge) embolized MCA aneurysm

Abstract

A 78 year old white female presented with TIA symptoms when an incidental 11mm right MCA aneurysm was encountered on MRI. The aneurysm was treated with a 10mm WEB SLS device resulting in a WEB occlusion scale B result. Her 6 month surveillance angiogram revealed a 9mm x 3mm recurrence anterior and inferior to the WEB device. The recurrence was treated with stent assisted coiling. 7 months after her retreatment, she suffered a right MCA stroke secondary to a coil that migrated out of the aneurysm and embolized in a distal M3 branch. Her 6 month surveillance angiogram following the retreatment revealed another small neck remnant and the migrated coil appeared to have travelled more distally. 5 days after her last angiogram, she presented to the hospital unresponsive with subarachnoid haemorrhage secondary to a ruptured right MCA aneurysm. Hospice care was chosen and the patient died 5 days later.