Abstract 4344958: Imaging-Guided Retrieval of a Migrated Coil from the Right Atrium: A Multimodal Endovascular Approach

Abstract

Introduction: Foreign body migration into cardiac chambers is a rare but potentially life-threatening complication of vascular interventions such as gonadal vein embolization. Migration of coils into the right atrium (RA) may lead to thromboembolism, valvular injury, arrhythmias, or perforation. Prompt recognition and retrieval are essential to avoid complications. Research Question: Can a percutaneous approach safely and effectively retrieve a migrated embolization coil from the right atrium in a stable young adult? What technical considerations and device strategies increase success in such complex retrievals? Goals/Aims: To describe a challenging case of right atrial embolization coil retrieval using advanced endovascular techniques and to highlight the importance of individualized procedural planning in high-risk patients. Case Presentation: A 27-year-old female presented with pleuritic chest pain, dizziness, and a history of prior gonadal vein embolization. Imaging revealed a metallic foreign body in the right atrium. Transthoracic echocardiography (TTE) and CT confirmed coil presence (2.25 × 1.25 cm) affixed to the RA roof. Multidisciplinary decision-making favored a percutaneous approach. Preprocedural TEE was performed for localization. Retrieval attempts included use of multi-loop snares, J-wire looping, balloon trapping (Cordis balloon), and ultimately AngioVac aspiration with ECMO backup. An Amplatz Super Stiff wire facilitated device support. Management/Outcome: Initial snare attempts led to fraying and partial coil removal. Sequential strategies including balloon trapping via right internal jugular access and mechanical aspiration with AngioVac were employed. A 7 × 20 mm balloon was inflated within the AngioVac sheath at 23 atm to trap the coil. Successful en bloc removal was achieved under fluoroscopy and confirmed by intraoperative TEE. The patient remained hemodynamically stable and was discharged the following day without complications. Conclusion: Percutaneous retrieval of migrated intravascular coils can be successful with advanced planning and a stepwise escalation of techniques. Success hinges on detailed imaging, anatomical understanding, and availability of equipment such as snares, balloons, and vacuum-assisted retrieval systems. While percutaneous removal is preferred, procedural flexibility and surgical backup are critical in complex cases.