Monorail snare technique for retrieval of stretched coil

Patient

• 47 y/o female patient, acute right limb weakness
• SAH, IVH, aneurysm of the interpeduncular fossa and AVM in the cerebellar vermis

Left SCA aneurysm / Cerebellar vermis AVM

Stent-assisted coil embolization

Gamma-Knife radiosurgery for AVM

2-year follow-up

Under GA coil embolization

• Envoy DA guiding catheter
• Headway 17 microcatheter
• Transend EX soft tip
• Target coil

Irremovable coils

Stretched coil

Microsnare

Amplatz Goose

Neck snares and microsnares

• Prowler Plus 0.021”
• Rebar 18  0.021”
• XT-27  0.027”
• Marksman  0.027”

Microsnare “monorail technique”

without flash system / with flash system

Without flash system

With flash system

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Causes of coil trouble

Diminishing “one to one motion” is the earliest alarm

• Coil stretching could result in difficult embolization, thromboembolic event or parent vessel occlusion
• Microsnare with monorail technique can be a safeguarding lasso modality for undesirably stretched or prematurely detached coil that still remained in the delivery microcatheter
• Capture the unstretched portion of the coil close to the aneurysm