• Yoichi Miura, Naoki Toma, Tomonori Ichikawa, Yume Suzuki, Hirofumi Nishikawa, Ryuta Yasuda, and Hidenori Suzuki.
• Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. Electronic address: yoimiu20@gmail.com.
• World Neurosurg. 2023 May 1; 173: 263267263-267.

ObjectiveAlthough snares are useful devices to retrieve an intravascular foreign body, the control of snares is often difficult. We present a safe and effective technique to adjust snare position in the tortuous vessel for coil retrieval during endovascular coil embolization.MethodsWe describe a case of a protruding coil during coil embolization that was successfully retrieved using a unique technique to adjust snare position and discuss additional intraprocedural bailout strategies for retrieving a coil during endovascular coil embolization.ResultsThe patient was a 44-year-old female with unruptured right internal carotid artery (ICA) aneurysm that had grown over a 1.5-year period. Coil embolization was performed. After detachment of final coil and microcatheter removal, the final coil protruded into the ICA and floated. Coil retrieval using a snare was attempted, but the snare could not be placed around the coil tail and coil retrieval could not be achieved. The following technique was used to allow adjustment of snare position. First, a microguidewire and a microcatheter were guided into the M2 and M1 segment of the middle cerebral artery as monorail guides of the snare, respectively. Next, the snare was advanced over the microcatheter. Around C2 segment of the ICA, the microcatheter and the snare were manipulated as a unit. Thus, the snare could be placed around the protruding coil tail and the coil was retrieved successfully.ConclusionsThis technique may be widely adapted for various situations when using a snare.Copyright © 2023 Elsevier Inc. All rights reserved.

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