Snare, stent retriever, and aspiration for a prematurely detached coil during treatment of a reruptured anterior communicating artery aneurysm

Advanced salvage techniques are an essential tool in the armamentarium of any experienced endovascular surgeon. In this video, we show a patient presenting with rerupture of an anterior communicating artery (ACoA) aneurysm that had been treated with balloon-assisted coiling several months earlier in a ruptured setting. Premature coil detachment occurred during an attempt to coil a new bleb that the aneurysm had developed, and a sequence of salvage maneuvers was performed. An initial attempt to implant that coil failed, and retrieval with a snare unfortunately caused coil fragmentation and occlusion of the anterior cerebral artery (ACA). Further salvage maneuvers required inducing flow-arrest with a balloon-guide catheter, use of a stent-retriever to recanalize the ACA A2 segment, and aspiration to capture a small fragment of coil that was seen at the tip of the balloon guide catheter.