Sticking after detachment procedure of coil with floating detachment link with ball joint due to excessively bent junction: A case report and a bench-top experiment.

Abstract

Background: We present a case of coil sticking, likely caused by an excessively bent junction of the coil and the delivery pusher, with a bench-top experiment to determine the cause of coil sticking in this case.

Case description: A coil embolization procedure was performed for an internal carotid artery aneurysm. During the framing with the Axium Prime Frame coil, the tip of the microcatheter was advanced to the center of the coil mass within the aneurysm to insert the coil. After detachment, the coil became stuck. Pulling the delivery pusher allowed the coil to detach from the delivery pusher within the microcatheter. After flushing the microcatheter with heparinized saline, the proximal end of the coil fortuitously settled within the aneurysm and the procedure was concluded without complications. A bench-top experiment suggested that an excessively bent junction of the coil and the delivery pusher causes the ball joint of the floating detachment link to hook into the circular opening.

Conclusion: When using coils with a floating detachment link that has a ball joint, forcibly advancing the microcatheter while the tip of the microcatheter is aligned with the junction may cause excessive bending of the junction, resulting in coil sticking.