Received: 13 July 2023 | Revised: 4 August 2023 | Accepted: 14 August 2023

DOI: 10.1002/ccd.30821

REVIEW

Coils embolization use for coronary procedures: Basics,

indications, and techniques

Shu Xian Loh MD1 | Emmanuelle Brilakis MD, PhD2 | Gabriele Gasparini MD3 |
Pierfrancesco Agostoni MD4 | Roberto Garbo MD5 | Kambis Mashayekhi MD6 |
7 8
Khaldoon Alaswad MD | Omer Goktiken MD | Alexandre Avran MD9 |
Paul Knaapen MD, PhD10 | Alex Nap MD10 | Ahmed Elguindi MD11 |
Khalid Tammam MD12 | Masahisa Yamane MD13 | Gregg W. Stone MD14 |
Mohaned Egred BSc (Hons), MB, ChB, MD, FRCP, FESC1,15,16
1
Cardiothoracic Department, Freeman Hospital, Newcastle upon Tyne, UK
2
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
3
Department of Invasive Cardiology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
4
HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
5
Interventional Cardiology Department, Maria Pia Hospital, GVM Care & Research, Turin, Italy
6
Internal Medicine and Cardiology, MediClin Heartcenter, Herzzentrum Lahr, Hohbergweg, Germany
7
Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan, USA
8
Memorial Hospital, Istanbul, Turkey
9
Valenciennes Hospital, Valenciennes, France
10
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
11
Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
12
Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia
13
Saitima St. Luke's International Hospital, Tokyo, Japan
14
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
15
Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
16
School of Medicine, University of Sunderland, Sunderland, UK

Correspondence
Mohaned Egred, BSc (Hons), MB, ChB, MD,
FRCP, FESC, Cardiothoracic Department,
Freeman Hospital, Newcastle‐Upon‐Tyne NE7
7DN, UK.
Email: m.egred@nhs.net
Abstract
The use of coils is fundamental in interventional cardiology and can be lifesaving in
selected settings. Coils are classified by their materials into bare metal, fiber coated,
and hydrogel coated, or by the deliverability method into, pushable or detachable
coils. Coils are delivered through microcatheters and the choice of coil size is
important to ensure compatibility with the inner diameter of the delivery catheter,
firstly to be able to deliver and secondly to prevent the coil from being stuck and
damaged. Clinically, coils are used in either acute or in elective setting. The most
important acute indication is typically the sealing coronary perforation. In the

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

Catheter Cardiovasc Interv. 2023;1–12. wileyonlinelibrary.com/journal/ccd | 1

 1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
2 | LOH ET AL.

elective settings, coils can be used for the treatment of certain congenital cardiac
abnormalities, aneurysms, fistulas or in the treatment of arterial side branch steal
syndrome after CABG. Coils must always be delivered under fluoroscopy guidance.
There are some associated complications with coils that can be acute or chronic, that
nictitates regular followed‐up. There is a need for education, training and regular
workshops with hands‐on to build the experience to use coils in situations that are
infrequently encountered.

KEYWORDS
CAD‐coronary artery disease, coil/device/transcatheter, COMI‐complications, complex PCI,
CTO‐percutaneous coronary intervention, EMBC‐embolization, IDI–interventional devices/
innovation, PCIC‐percutaneous coronary intervention

1 | INTRODUCTION AND HISTORIC 2 | CLAS SIFICATIO N OF CO ILS

PERSPECTIVE
Although the use of coils can be a life‐saving procedure for treating
coronary perforations, cardiologists who receive limited training in
this field as coils are used infrequently.
A recent worldwide survey reported that 64% of interven-
tional cardiologists have never used coils in their practice.1 Most
publications on coils utilization during percutaneous coronary
intervention (PCI) have been either case reports or single center
retrospective studies. In a large single center series, coils were
used in 0.03% (41 out of 121,196 PCI procedures).2 With
increasing age and complexity of coronary artery disease,3–5
the incidence of coronary perforation is likely to increase
highlighting the importance of interventional cardiology educa-
tion on the basics of coils, including design, materials, indications,
and mode of delivery.
The use of coils for percutaneous vessel embolization was first
reported by Gianturco6 who designed a mechanical occlusive device
consisting of 3 mm gauge steel segments attached to several strands
of cotton threads, which was then delivered via the femoral artery
into several different branches of arteries of 10 anaesthetized dogs,
successfully occluding the coronary, renal, coeliac and superior
mesenteric arteries.6
Multiple different types of coils have been developed by
different companies and are widely used in different medical,
surgical and interventional specialties nowadays. The most well‐
known uses of coils are in the treatment of both ruptured and
unruptured cerebral aneurysms in Neurosurgery, in preventing
catastrophic events of intracranial bleeds such as subarachnoid
hemorrhages, which can lead to death. However, the use of coils
has also widely expanded and has now been increasingly used as
less invasive methods in embolizing pulmonary, gastrointestinal
and uterine vessels for many different indications. The goal of the
present review is to explore the utilization of coils in adult and
congenital cardiology patients in both the acute and the elective
setting.
Coils are put in place permanently and as such, biocompatibility is a
key property to ensure sustainability in the human body.7
Most evidence for the use of coils has come from neurosurgery and
intracranial use due to the vast volume of use in this area. This has been
extrapolated to the use in other different vascular beds. For example,
depending on aneurysm size, a cerebral aneurysm typically uses a much
smaller and softer coil with wire diameter of 0.010−0.012 in. On the
contrary, embolization of pulmonary vasculature, larger coils with wire
diameters of 0.035−0.038 in. are typically used.
Coils can be classified by material and coating (three categories,
bare metal (typically Platinum or Nitinol based) coils, hydrogel coated
coils, and fibered coils) and by method of delivery (Figure 1).
3 | M A T E R I A L S AN D C O A T I N G OF CO I L S
The main material of a coil typically consists of inert metals such as
platinum, nitinol (composite of nickel and titanium) or iconel (an
austenitic nickel‐chromium‐based superalloy). Using an inert material
helps to prevent graft versus host reaction.7 In addition, the use of
different metals provides different levels of rigidity with nitinol being
the least rigid.
The metal then undergoes a series of configuration which
includes primary, secondary and tertiary configuration.
The primary configuration is creating a wire ranging between
0.00175 and 0.003 in.7 and determines the stiffness of the coil used.
The secondary configuration involves winding the wire around a
mandrel of different sizes which gives a second diameter ranging
between 0.010 and 0.038 in.7 This diameter is the diameter used to
measure against the delivery catheter internal diameter, to ensure
that the coil can be passed through and delivered.
This is especially important for treating perforation during PCI
where microcatheters are being used. Having coronary
microcatheter‐compatible coils allows delivery through the micro-
catheter already in use and will save time.

LOH ET AL.
FIGURE 1 Classification of coils by materials and coating and by delivery method. [Color figure can be viewed at wileyonlinelibrary.com]
F I G U R E 2 Relationship between microcatheters and coils by inner and outer diameter. [Color figure can be viewed at
wileyonlinelibrary.com]
The currently available microcatheters have a wide range of
internal diameter, with the smallest having an internal diameter of
0.015 in. at the tip. The narrowest internal diameter of the
microcatheter determines the smallest diameter of guide wire, coils
or any other equipment that can be delivered through it. As a result,
<0.014 in. is the largest coil diameter that can be delivered through
coronary microcatheters such as the Axium coil (Medtronic) that has
an outer diameter of 0.0108−0.0125 in. (Figure 2).
Finally, and in the tertiary configuration, the wire is then
constructed into a three dimensional model taking the shape of
either, straight tip, helical coil, vortex coil, multiloop, framing coil, and
7
many others.
The different shapes allow for different coils to be used in
different ways. For instance, framing coils are used to frame the lining
of an aneurysm walls while multiloop coils are used for packing to
1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 3
encourage thrombogenicity. Hence, multiple coil types may be
needed to occlude a vessel.
The Guglielmi detachable coils (GDC) that was invented by
Guglielmi in 1990, has revolutionized the endovascular treatment of
cerebral aneurysms in the world of neurosurgery.8,9 However,
multiple studies had demonstrated a flaw in the invention whereby
long‐term recanalization was a proven complication of the GDC
system, which was mainly just a bare metal framework without any
additional coating.8–10 Hence, any additional substrate that promotes
thrombogenicity using less coils as well as reducing long‐term
complications of recanalization was welcomed. This led to the
invention of fibered and hydrogel coated coils.
Hydrogel coated coils are platinum based coils coated with a
cross‐link material which is able to absorb water but is non‐
dissolvable or degradable when it happens, creating a gel‐like

4 |
material.11,12 The use of this bioactive material allows for the coil to
swell up to three to four times its initial diameter when it comes to
contact with blood as the activating solvent. This typically takes
about 3 min for the coil to expand to 80% and about 20 min for its
maximal expansion11,13 and allows for an increase in packing
density.14
A meta‐analysis of randomized controlled trials which compared bare
metal coils to hydrogel bioactive ones demonstrated a higher rate of
aneurysm occlusion in patients who received hydrogel‐coated coils as
compared to bare metal ones.15 In addition, another single center study
demonstrated a reduction in the number of coils needed to be used with
the use of hydrogel‐coated coils as compared to bare platinum coils.16
However, a randomized controlled trial performed in 24 centers
comparing hydrogel versus bare platinum coils demonstrated no
difference in terms of patients' long‐term outcomes, but did concur to
a reduction in major recurrence of cerebral aneurysms.14
Fibered coils ordinarily use several materials such as nylon,
polyglycolic‐lactic acid (PGLA) and polyethylene terephthalate multi-
filament fibers to achieve a high level of thrombogenicity. However,
in comparison to hydrogel‐coated coils, the evidence available for
fibered coils is limited. One study which looked at patients in a single
center across 9 years demonstrated an improvement in the occlusion
17
rate with fibered coils in comparison to bare coils. However in a
swine model study, fibered coils demonstrated a reduction in
quantity of coils required to achieve complete occlusion, in
comparison to bare metal coils, but recanalization rate were similar
18
on both arms.
To date, only two studies in humans19,20 and one in sheep21 have
compared the use of hydrogel‐coated coils versus fibered coils.
Although significantly underpowered, only 43 patients randomized
into three separate groups, and being a single center, the study
demonstrated that both fibered and hydrogel coils had achieved
embolization of target vessel. However, more fibered coils are used
compared to number of hydrogel coils to achieve complete
occlusion.19 Another more recent Japanese multicentre, single‐
blinded, prospective study looked at 77 patients who were coiled
for a variety of peripheral vascular lesions. Despite multiple
limitations and not directly comparing hydrogel with fibered coils,
this study demonstrated a reduction in the number of coils needed in
the hydrogel arm compared to the nonhydrogel arm.20
4 | DELIVE RY ME THOD
The other method of classifying coils is by delivery mechanism as
pushable or detachable.
Pushable coils, like detachable one, can be bare metal, fibered or
coated in hydrogel envelope.
There are two main methods of delivering a pushable coil. The
first is by using a guide wire or designated pusher wire to advance
and deploy the coil past the catheter tip, “push technique.” The
second method, called the “flush technique” which forces the coil out
from the delivery catheter using a Luer Lock syringe and forcefully
1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
LOH ET AL.
flushing saline to deploy the coil to a specific area. It is a faster and
cheaper way of coil delivery but can be unpredictable, lacks precision,
and dislodgement of the coil from its targeted area of interest can
occur.
Detachable coils are typically attached to a wire that allows the coil
to be delivered to the target area but not released. If the achieved
position in not satisfactory, then the coil can be retracted and
repositioned. Once the position and coiling density is satisfactory in the
specific vascular structure, the detachable coil can be released using one
of three mechanisms, electric, mechanical, or hydraulic detachment.
5 | MRI COMPA TIBILITY AND ARTEFACT
Most coils are considered magnetic resonance imaging (MRI)
conditional, meaning that patients can be safely scanned if placed
under specific MRI conditions. Most coils can be scanned with a static
magnetic field between 1.5 and 3.0 Tesla with a maximum spatial
gradient field of 5000 Gauss/cm. There is also a certain amount of
MRI‐related heating of the coils, however this is minimal, ranging
from a minimum of 0.6°C increase to a maximum of 3.1°C.
Like any metal, coils can cause a certain degree of artefact and
compromise to the image taken. This is particularly true for areas of
interest that are nearer to the coil, therefore optimization of MR
imaging parameters to compensate for the presence of the coil may
be necessary. Image artifacts can extend between a diameter of
5.7−41.3 mm from the coil depending on individual products.
For precise MRI specification and artefact radius affected by
each coil, the product specification would tell their MRI conditional-
ity. Alternatively, the website “MRI safety.com” gives a comprehen-
sive list of MRI conditionality to each product of coil currently
present in the market.
6 | I N D I C A T I O N S FO R U S E OF CO I L S
The use of coronary coils during PCI has received limited study due to
their limited use.
Coronary coils are used during PCI for acute or for elective
indications. Acute indications are typically due to coronary artery
perforation (CAP). Elective indications include, occlusion of aneur-
ysms or pseudoaneurysms, occlusion of coronary artery fistula (CAF),
branch occlusion to prevent coronary artery steal, occlusion of
saphenous vein grafts following native artery PCI, and certain
congenital abnormalities (Figure 3).
7 | ACUTE INDICATIONS FOR COIL
EMBOLIZA TION
CAP is a rare but potentially life threatening complication of PCI with
an incidence rate of 0.2‐0.5%.5,22–24 Coronary perforations are
classified by location (large proximal vessel, distal vessel, and

LOH ET AL.
FIGURE 3 Indications for coils, acute, and chronic. [Color figure can be viewed at wileyonlinelibrary.com]
collaterals perforation) and by size (Ellis classification).3,5,25,26 Risk
factors for coronary perforation include PCI of complex lesions, type
B and C lesions, which include calcific lesions, tortuous anatomy,
female, and elderly.5,25,26
CAP can be divided by means of anatomical region; main vessel
perforation, distal wire perforation or collateral vessel (either septal
or epicardial collaterals) perforation.
Distal perforations typically occur due to wire migration and is
commonly associated with the use of hydrophilic, polymer‐jacketed wires,
(88.9% of CAP reported as due to hydrophilic wires).5,27–29 Unlike main
vessel CAP which can be treated with covered stents, distal perforations
are often too small to utilize covered stent and are usually treated by
2,5,27,30
embolization using coils or other methods such as fat embolization.
There has been a significant increase in CTO PCI and complex
procedures that led to an increase in the risk of complications,
particularly perforations, and in turn to an increase in the need for
coronary coils. The risk of perforation increases further in retrograde
CTO PCI as compared to antegrade approach, making it an
independent predictor of risk for perforation in CTO procedures.31,32
Special care must be paid to CTO perforations as unlike non‐CTO
procedures, septal or epicardial collaterals have a dual source of
blood supply and occluding one source may not suffice and both
retrograde and anterograde collaterals may both have to be
33,34
embolized to stop any further bleeds.
The invention of microcoils of the Axium range (in bare metal as
well as fiber‐coated versions) by Medtronic, has allowed for easier
deliverability of microcoils via the smallest diameter microcatheter
used such as Asahi Corsair or Caravel that are commonly used in CTO
PCI procedures.
8 | ELECTIVE INDICATIONS FOR COIL
EMBOLIZATION
Coronary artery aneurysms (CAA) are one of the elective indications
for coil embolization.35,36 In addition, coils can be considered in an
acute setting for a ruptured pseudoaneurysm.37 CAA can be found up
1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 5
to 5% of patients who have undergone coronary angiography.38 They
are more likely to be found incidentally now with the increasing use
of coronary computer tomography angiography (coronary CTA)
although coronary angiography remains the gold standard for
CAA.39 More recent papers have suggested < 1% of true CAA
incidence amongst the population.
The majority of CAA in adults are predominantly a result of
atherosclerosis with a quoted data ranging between 52% and 90%.39,40
Other reasons include congenital abnormalities due to genetic
susceptibility,41 vasculitic or connective tissue predisposition,42 as
well as iatrogenic cause from trauma of percutaneous coronary
procedure.43,44
Although some patients may be asymptomatic, there is signifi-
cant importance of the treatment of CAA as these patients can often
be surgical turn downs, with significant effort angina or acute
coronary syndromes (due to turbulence in aneurysms that predis-
poses to development of thrombus).40,45 If left untreated, CAA have a
risk of forming fistula or in other rare circumstances, a weakened wall
tension of the aneurysm itself predisposes the aneurysm to
rupture46,47 with resulting cardiac tamponade and possibly death.48
Therefore, a complete packing of the aneurysm is important and
requires multiple and different types of coils to ensure complete
coverage and obliteration,49 (if coils are chosen instead of covered
stent).
Another elective indication for coiling is for the occlusion of CAF.
CAF is an abnormal connection between a coronary artery and a
cardiac chamber or vessel, which is typically congenital but can also
be acquired. The prevalence of CAF in the general population is
estimated at 0.002%,50 with an incidence of 0.09‐0.2% of those who
have undergone coronary angiography.51 Patients with CAF are
typically asymptomatic.52 However, in those who are symptomatic, it
is typically associated with the mechanism of “coronary steal
syndrome” which may manifest as effort angina or dyspnoea.50
As stated in the 2020 European Society of Cardiology guidelines,53
small fistulas typically have good prognosis when left without treatment.
Nonetheless, medium or large fistulas are often associated with
symptoms as well as long‐term complications including angina, myocardial

6 |
infarction, heart failure and infective endocarditis.53 As such a per-
cutaneous or surgical modality of closure is crucial in these patients, and
their clinical indications for closure relates to symptoms, complications, or
presence of shunting. The use of percutaneous approach as compared
with surgical repair is associated with shorter hospitalization and faster
recovery. An adequate number of coronary coils need to be used to avoid
future recanalization of fistula which can cause a recurrence of symptoms
and the need for repeat intervention.
Other rarer congenital cardiac abnormalities have also been managed
by coil embolization technique as a successful form of treatment that can
be used in both pediatric and adult population of patients. A review
article54 described the use of coil embolization in the treatment of patent
ductus arteriosus (PDA), different types of aortopulmonary arterial
collaterals as well as other forms of systemic to pulmonary collaterals.
Although a more commonly used device for PDA closure is an Amplatzer
ductal occlude. Occasionally, stainless steel or platinum coils can be used
too for PDA which are <2−3 mm in size or in the presence of residual
54,55
leak. Aortopulmonary collaterals can be a congenital anomaly, or a
deliberate iatrogenic treatment for certain congenital heart disease
patients such as in Fontan's procedure or Blalock‐Taussig or modified
Blalock‐Taussig shunts.56 The embolization of these collaterals is
indicated to avoid the development of pulmonary arterial hypertension
which can occur if too many of these collaterals overload the pulmonary
low pressured system.
Since the establishment of the left internal mammary artery use
as a conduit for coronary bypass, there has been several case reports
which have documented large left internal mammary artery (LIMA)
side branches causing coronary steal effect causing angina‐type
symptoms, despite the rest of the grafts being patent.57 This case
series of seven patients demonstrated that the five patients who had
complete occlusion of their side branch after coil embolization, had
complete symptom resolution.
A recent review of all LIMA side branch coiling case reports from
1990 to 2018 demonstrated 44 patients whodescribed such
symptoms with LIMA grafts.58
Out of the 31 publications, 15 publications57,59–72 had utilized coil
embolization as the modality of percutaneous closure either as a stand‐
alone method or in combination with other additional techniques.
Most of these case report/series demonstrated success in coil
embolization in the treatment of LIMA side branch steal syndrome,
that is, complete symptoms relief. Although one paper demonstrated
a rare complication of coil with uncoiling with symptoms recurrence
despite being initially ameliorated with the initial successful coiling.73
Overall, most papers have revealed good outcomes from the use
of coronary coil embolization techniques to manage coronary steal
syndrome.
9 | METHOD OF DEL I VERY
Coil delivery must be done under a careful fluoroscopy guidance to
achieve long‐term occlusion of the intended structure, and a
combination of several techniques can be used. A Coaxial technique
1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
LOH ET AL.
is when a coaxial delivery catheter is placed within a guiding catheter
to provide stability and support, whilst the coaxial delivery catheter is
used to maneuver the coil into its appropriate position. This method
allows for prevention of coil elongation and ensures long‐term
occlusion by delivering sufficient packing of coils.
The anchor technique is typically used when there are concerns
with regard to the stability of coils and coil migration. This technique
deploys a proportion of coils into a vascular side branch, therefore
anchoring it inside and consequently sacrificing the side branch in
question. Then, the rest of the coil is deployed and tightly packed to
the proximal end of the side branch with additional coils used to pack
the area. This method is more relevant to peripheral embolization
rather than coronaries.
The last technique is the scaffold technique that is typically used
in high flow vessels. This technique is particularly used when softer
coils are needed but the risk of coil propagation and migration is
significant. Therefore, initially, a high radial force coil can be placed
proximal to the area of intended occlusion. Then several other softer
coils are used to pack the area to ensure thrombogenicity and
adequate embolization of the area distal to the occlusion.
Although the technique of coil delivery is crucial, the equipment
used to aid delivery is equally as important. The size of catheters used
during intervention influences what coils can be used.
A common microcatheter is the Progreat (Terumo, Somerset,
New Jersey) that has an internal diameter ranging between 0.019 and
0.027 in. The larger internal diameter of the Progreat can accommo-
date most coils available in the market, be it bare metal, fibered or
hydrogel laced coils.
Currently, there are multiple 0.014 in. coils in the market that are
compatible with the microcatheters that are used in PCI and
particularly in CTO PCI (Table 1).
The Axium range of microcoils, manufactured by Medtronic, and
one of the smallest range of microcoils in the market, with an outer
diameter ranging from 0.0108 to 0.0135 in. that is compatible with
the size of the inner diameter of a small microcatheter. These
microcoils are used in neurosurgery and come in bare metal form as
well as fibered version (overlapped with nylon or PGLA microfila-
ments). The larger the diameter of the coil, the more stable they are
during release. However, in the event of a CAP, a coil with a diameter
of 0.010 would suffice to tamponade the bleed.74
The method of deployment of coils also depends on the type of
coil used. Moreover, as previously highlighted, there are different
delivery methods of coils that include the pushable or detachable
coils. Detachable coils typically utilize one of three system of
deployment, electrical, mechanical, or hydraulic.
The electrically detachable coils use a high frequency electrical
current that generates heat allowing for the disruption of the junction
between the platinum coil and its delivery system.75
The mechanically detachable coils such as the Interlock IDC
Detachable Embolization Coils (Boston Scientific) detaches the coil
once its position is confirmed. The mechanical release system
uncouples the interlocking proximal end of the coil from the distal
end of the pusher wire which means that the interlocking system can
 1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
LOH ET AL. | 7

TABLE 1 Neurovascular coils and 0.014‐in guide wire compatible microcatheters.

Manufacturer Coil name Description Detachment system Descrition

Microvention Hydrocoil (HES) HES: bare platinum coil combined with as expanding hydrogel V‐Grip Thermo
polymer. MCS: Bare platinum coil with various shapes and mechanical
MicroPlex (MCS)
softness profiles

Codman Orbit Cerecyte Orbit: bare platinum coil with various shapes and softness profiles. EnPower Thermo
Cerecyte: bare platinum coil with PGA member with coil core mechanical

Stryker Target Bare platinum coil with various shapes and softness profiles InZone Electrolytic

Medtronic Axium Bare platinum coil with or without PGLA or Nylon microfilaments Axium I.D. Mechanical
enlaced through the coil

Max Shaft Usable

Manufacturer Catheter name Guide wire OD Size OD Length

Microvention Headway Duo 0.014″ Proximal 2.1 F 156 cm

Distal 1.6 F

Codman Prowler 14 0.014″ Proximal 2.8 F 150 or 170 cm

Distal 1.9 F

Stryker Excelsior SL‐10 0.014″ Proximal 2.4 F 150 cm

Distal 1.7 F

Medtronic Echelon‐10 0.014″ Proximal 2.1 F 150 cm

Distal 1.7 F

Abbreviation: PGLA, polyglycolic‐lactic acid.

only be retracted if it remains inside the delivery catheter as once it
has come out, it detaches, therefore limiting its precision of
deployment.76 The hydraulic method of deployment utilizes the
hydraulic pressure from the detachable coil syringe to transfer its
pressure to the distal tip to activate the elastomeric gripper. The
pressure causes the gripper to gently release the coil and deployment
into position.77
The detachable method of deployment allows a higher precision
and accurate positioning of coils, and a lower number of coils needed,
however each coil can be much more expensive than its pushable
counterpart.
Pushable coils on the other hand can be delivered by two
different methods that include the “saline flush technique” or the
“push technique.”78 The “saline flush technique” utilizes a 1−3 mL
syringe filled with heparinised saline solution. The solution is
forcefully injected to deploy the coil to the intended area. In the
instance of a bleeding structure, due to the hydrostatic pressure from
the flush solution, it may cause a dislodgement of the thrombus and
instigate recurrent bleed, which provides an advantage of the “push
technique” over the “saline flush technique” in such situation.
With the “push technique,” a coil pusher is used to push the
coil out in a controlled fashion. The coil pusher should closely meet
the size of the internal diameter of the microcatheter or catheter
used to avoid the pusher from being wedged between the coil and
the catheter used, which can cause damage to the device.78 The
“saline flush technique” perceived strengths over the “push
technique” are that a specific, precisely sized coil pusher is not
required and this allows for faster deployment of coils.79 Despite
the fact that pushable coils do not allow for precision positioning,
they allow for faster delivery and can be used for packing of
aneurysms or fistulas if needed and are cheaper than the
detachable option.
10 | CO MPLICATIONS
Coil deployment even in the hands of experienced operators can be
associated with significant complications. These complications can be
classified into acute and chronic (Figure 4).
11 | ACUTE COMPLICATIONS
Two of the more common acute complications are coil migration and
premature coil detachment.
Coil migration is more common with pushable coils.52,80,81 Due
to the forceful injection of flushed saline, the coil may migrate
from the area of interest. Inappropriately sized coils which can be
too long and not appropriately compacted, or undersized can also
migrate.76,82
Due to the nature of the fibered and hydrogel coils, as they
encourage thrombogenicity, they can cause myocardial infarction.52,83
In situations such as these, there are two main options: retrieval or
anchoring the migrated coil.

8 |
F I G U R E 4 Complications of coils, acute, and chronic. [Color
figure can be viewed at wileyonlinelibrary.com]
Retrieval can be done using snares,84 but anchoring by
implanting a stent over it is often preferred. Very distally migrated
coils are often left in place and prolonged dual antiplatelet therapy
may be considered for such cases.
Another common concern is the premature detachment of coils.
This phenomenon can occur with any modality of deployment of
coils, both pushable or detachable,85 and typically occurs when the
coil has been extensively manipulated to achieve an appropriate
positioning. This can occur within the delivery microcatheter, or in
the vessel or structure that is being coiled.
In the event where a detachable coil is used and the coil has been
roughly positioned in the appropriate area, but has been prematurely
realesed inside the microcatheter, the affected coil can still be
deployed using the disconnected pusher wire to push the coil out of
the microcatheter, and completely deploy it. However, if the coil
needs to be removed, one technique that can be used is with the help
of a syringe. A syringe is attached to the end of the microcatheter to
provide negative suction pressure, both the coil and the micro-
catheter can be removed simultaneously together.82 This method can
only be used provided the coil has been partially deployed inside the
microcatheter. If the coil has already been fully deployed out of the
catheter or if the syringe technique has been unsuccessful, stenting
of the end of the coil or using snaring devices such as microsnares to
85
retrieve the coil may need to be considered.
There are other rare acute complications that can occur during
the use of coils. There are case reports of coil knotting,86
stretching87 as well as aneurysm rupture,88 that can occur,
however these events are rare. Coil knotting had been described
by a team from Korea after significant manipulation of coil had
been carried out which had caused the coil to loop against itself
and alter its configuration and hence forming a knot. Occasionally,
the knotted coil can be retracted into the microcatheter and
removed successfully, however in the event of this situation, the
team had decided to use the microcatheter to guide the removal of
1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
LOH ET AL.
the coil together. Another option is to completely push and deploy
the affected coil into the area of interest.
Coil stretching is another rare complication which can occur
during its use. It occurs when the primary wind has been unwound
which causes a reduced “one to one” motion. This complication is
typically seen when significant amount of manipulation has been
carried out to shape the coil to its appropriate shape, causing
stretching and therefore unwinding the coil. The coil can be either
retrieved using a snare in such occasions, or anchored to the parent
artery.82 Finally, there is the risk of aneurysmal rupture, although
there has been no report of such event in the PCI field, it is a real risk
and has been documented in neuroradiology case report87 with
intracranial aneurysm ruptures, and therefore care must be taken
when deploying these devices.
12 | C H R O N I C CO M P L I C A T I O N S
Recanalization of vascular structures has been demonstrated in a
case report whereby patient who had a complete occlusion of their
fistula between the left anterior descending artery and left pulmo-
nary artery, had redeveloped symptoms. A repeat angiogram which
demonstrated recanalization of the coiled artery.89 Another observa-
tional retrospective paper demonstrated similar complications.52,83
However, it has also been demonstrated that the outcomes of
percutaneous closure of fistulas was comparable to the outcomes
from surgery90 and should be considered an option for patients,
provided they are done in experienced centers. Hence, recanalization
can either be treated by means of further coiling or surgical tie off.83
The main risk factor was thought to be the presence of residual flow
immediately after procedure. This tends to predispose the patient to
development of increased flow and consequently recanalization in
the future.
As such, despite most patients being asymptomatic, it has been
suggested that close follow up of these patients with follow‐up
imaging should be considered.
13 | CO NCL US I ON
Coils are rarely used in PCI but on occasion can have a life‐
saving role.
There are multiple kinds and shapes of coils based on their
materials (bare metal, hydrogel coated, and fibered coils) or delivery
method (pushable and detachable). Similarly, the diameter of the coil
varies and for coronary use, a small diameter (0.014 in.) that is
compatible with the microcatheters that are in clinical use, is
important to have available in the catheterization suit for immediate
use when required. In comparison, a larger diameter coils require a
special and a larger diameter delivery catheter that can prove difficult
to deliver during an emergency situation.
Familiarity and experience with coils and their use are important
skill and knowledge to acquire for any interventional cardiologist

LOH ET AL.
despite the infrequent use. Workshops and hands‐on training courses
could help interventional cardiologists learn and improve with coiling
techniques that is rarely used in clinical practice.
14 | SUMMARY
1. The use of coils is fundamental in the world of interventional
cardiology as it can be a life‐saving procedure in selected
settings.
2. Types of coils can be classified by material or deliverability
method.
3. Coils can be further classified into bare metal, fibered coated or
hydrogel coated forms.
4. Classified by means of deliverability, coils are typically divided
into pushable or detachable coils.
5. All coils are MRI conditional and this can be clarified from the
manufacturer The coil size choice is important to ensure
compatibility with the inner diameter of the delivery catheter
to prevent product being stuck and damaged.
6. Clinical indications for coils is divided into acute and elective
where acute settings are typically used for perforations while
elective settings can be used in treatment of certain congenital
cardiac abnormalities or in the treatment of arterial side branch
steal syndrome after CABG.
7. Coils must always be delivered under fluoroscopy guidance.
8. Different techniques are available in deploying coils.
9. There are associated complications with coils which can be
subdivided into acute and chronic complications, hence these
patients should be regularly followed‐up.
10. The need for regular workshops and hands‐on experience is
important in a field that is infrequently encountered.
CO NFL I CTS OF I NTEREST STATEM ENT
Emmanuelle Brilakis: Consulting/speaker honoraria from Abbott
Vascular, American Heart Association (associate editor Circulation),
Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular
Innovations Foundation (Board of Directors), CSI, Elsevier, GE
Healthcare, IMDS, Medtronic, Teleflex, and Terumo; research
support: Boston Scientific, GE Healthcare; owner, Hippocrates LLC;
shareholder: MHI Ventures, Cleerly Health, Stallion Medical. Roberto
Garbo: Consultant Boston Scientific, Terumo, Philips Volcano, IMDS,
CID‐Alvimedica. Kambis Mashayekhi: Consulting/speaker/proctoring
honoraria from Abbott Vascular, Ashai Intecc, AstraZeneca, Biotronik,
Boston Scientific, Cardinal Health, Daiichi Sankyo, Medtronic,
Teleflex, Terumo. Khaldoon Alaswad: Consultant and speaker for
Boston Scientific, LivaNova, CSI, Teleflex and Asahi. Alexandre
Avran: Proctor for Boston Scientific, Biotronik, Abbott, Terumo,
Biosensor, Medtronic. Ahmed Elguindi: Consulting Honoraria: Med-
tronic, Boston Scientific, Asahi Intecc. Proctorship fees: Medtronic,
Boston Scientific, Asahi Intecc, Terumo. Educational grants: Med-
tronic. Khalid Tammam: Proctor for Boston Scientific and Asahi.
Gregg W Stone: Reports having served as a consultant to: Matrizyme,
1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 9
Miracor, Neovasc, V‐wave, Shockwave, Valfix, TherOx, Reva, Vascu-
lar Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions and
Ancora; receiving speaker honoraria from Amaranth and Terumo;
holding equity in Ancora, Cagent, Qool Therapeutics, Aria, Caliber,
MedFocus family of funds, Biostar family of funds, Applied
Therapeutics and SpectraWAVE; serving as a director in Spectra-
WAVE; and that his employer, Columbia University, receives royalties
for sale of the MitraClip from Abbott. Mohaned Egred: Proctorship,
Speaker's fee, honoraria from Abbott Vascular, Boston Scientific,
Philips, Spectranetics, Volcano, Vascular Perspective, Merrill, Sveltte,
Terumo, EPS Medical, Astra Zeneca. The remaining authors declare
no conflict of interest.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are openly available
in PUBMED at https://pubmed.ncbi.nlm.nih.gov/.
ORC I D
Emmanuelle Brilakis http://orcid.org/0000-0001-9416-9701
Pierfrancesco Agostoni http://orcid.org/0000-0002-1505-9369
Mohaned Egred https://orcid.org/0000-0003-3642-318X
RE F ER EN CES
1. Simsek B, Kostantinis S, Karacsonyi J, et al. International per-
cutaneous coronary intervention complication survey. Catheter
Cardiovasc Interv. 2022;99(6):1733‐1740. doi:10.1002/ccd.30173
2. Abdelfattah OM, Saad AM, Kassis N, et al. Utilization and outcomes
of transcatheter coil embolization for various coronary artery
lesions: single‐center 12‐year experience. Catheter Cardiovasc
Interv. 2021;98(7):1317‐1331.
3. Shimony A, Zahger D, Van Straten M, et al. Incidence, risk factors,
management and outcomes of coronary artery perforation during
percutaneous coronary intervention. Am J Cardiol. 2009;104(12):
1674‐1677.
4. Shaukat A, Tajti P, Sandoval Y, et al. Incidence, predictors,
management and outcomes of coronary perforations. Catheter
Cardiovasc Interv. 2019;93(1):48‐56.
5. Abdalwahab A, et al. Management of coronary artery perforation-
cardiovascular revascularization. Medicine. 2021;26:55‐60.
6. Gianturco C, Anderson JH, Wallace S. Mechanical devices for arterial
occlusion. Am J Roentgenol. 1975;124(3):428‐435.
7. White JB, Ken CGM, Cloft HJ, Kallmes DF. Coils in a nutshell: a
review of coil physical properties. AJNR Am J Neuroradiol.
2008;29(7):1242‐1246.
8. Viñuela F, Duckwiler G, Mawad M. Guglielmi detachable coil
embolization of acute intracranial aneurysm: perioperative anatomi-
cal and clinical outcome in 403 patients. J Neurosurg. 1997;86(3):
475‐482.
9. Tateshima S, Murayama Y, Gobin YP, Duckwiler GR, Guglielmi G,
Viñuela F. Endovascular treatment of basilar tip aneurysms using
Guglielmi detachable coils: anatomic and clinical outcomes in 73 patients
from a single institution. Neurosurgery. 2000;47(6):1332‐1342.
10. Murayama Y, Nien YL, Duckwiler G, et al. Guglielmi detachable coil
embolization of cerebral aneurysms: 11 years’ experience.
J Neurosurg. 2003;98(5):959‐966.
11. Ferral H. Hydrogel‐coated coils: product description and clinical
applications. Seminars in Interventional Radiology. Thieme Medical
Publishers; 2015.
12. Serafin Z, Di Leo G, Pałys A, Nowaczewska M, Beuth W,
Sardanelli F. Follow‐up of cerebral aneurysm embolization with

10 | LOH
hydrogel embolic system: systematic review and meta‐analysis. Eur
J Radiol. 2015;84(10):1954‐1963.
13. Kallmes DF, Fujiwara NH. New expandable hydrogel‐platinum coil
hybrid device for aneurysm embolization. AJNR Am J Neuroradiol.
2002;23(9):1580‐1588.
14. White PM, Lewis SC, Gholkar A, et al. Hydrogel‐coated coils versus
bare platinum coils for the endovascular treatment of intracranial
aneurysms (HELPS): a randomised controlled trial. Lancet.
2011;377(9778):1655‐1662.
15. Broeders JA, Ahmed Ali U, Molyneux AJ, et al. Bioactive versus bare
platinum coils for the endovascular treatment of intracranial
aneurysms: systematic review and meta‐analysis of randomized
clinical trials. J NeuroIntervent Surg. 2016;8(9):898‐908.
16. Poncyljusz W, Zarzycki A, Zwarzany Ł, Burke TH. Bare platinum coils
vs. Eur J Radiol. 2015;84(2):261‐265.
17. Liebig T, Henkes H, Fischer S, et al. Fibered electrolytically
detachable platinum coils used for the endovascular treatment of
intracranial aneurysms: initial experiences and mid‐term results in
474 aneurysms. Interv Neuroradiol. 2004;10(1):5‐26.
18. Trerotola SO, Pressler GA, Premanandan C. Nylon fibered versus
non‐fibered embolization coils: comparison in a swine model. J Vasc
Interv Radiol. 2019;30(6):949‐955.
19. Maleux G, Deroose C, Fieuws S, et al. Prospective comparison of
hydrogel‐coated microcoils versus fibered platinum microcoils in the
prophylactic embolization of the gastroduodenal artery before
yttrium‐90 radioembolization. J Vasc Interv Radiol. 2013;24(6):
797‐803.
20. Hongo N, Kiyosue H, Ota S, et al. Vessel occlusion using Hydrogel‐
Coated versus nonhydrogel embolization coils in peripheral arterial
applications: a prospective, multicenter, randomized trial. J Vasc
Interv Radiol. 2021;32(4):602‐609.
21. Fohlen A, Namur J, Ghegediban H, Laurent A, Wassef M, Pelage JP.
Peripheral embolization using hydrogel‐coated coils versus fibered
coils: short‐term results in an animal model. Cardiovasc Intervent
Radiol. 2018;41(2):305‐312.
22. Shimony A, Joseph L, Mottillo S, Eisenberg MJ. Coronary artery
perforation during percutaneous coronary intervention: a systematic
review and meta‐analysis. Can J Cardiol. 2011;27(6):843‐850.
23. Harnek J. Coronary artery perforation and tamponade―incidence,
risk factors, predictors and outcomes from 12 years’ data of the
SCAAR registry. Circ J. 2019;84(1):43‐53.
24. Kinnaird T, Kwok CS, Kontopantelis E, et al. Incidence, determinants,
and outcomes of coronary perforation during percutaneous coro-
nary intervention in the United Kingdom between 2006 and 2013:
an analysis of 527 121 cases from the British cardiovascular
intervention society database. Circ Cardiovas Intervent.
2016;9(8):e003449.
25. Fasseas P, Orford JL, Panetta CJ, et al. Incidence, correlates,
management, and clinical outcome of coronary perforation: analysis
of 16,298 procedures. Am Heart J. 2004;147(1):140‐145.
26. Stankovic G, Orlic D, Corvaja N, et al. Incidence, predictors, in‐
hospital, and late outcomes of coronary artery perforations. Am
J Cardiol. 2004;93(2):213‐216.
27. Ponnuthurai FA, et al. Microcoil embolization of distal coronary
artery perforation without reversal of anticoagulation: a simple,
effective approach. J Invas Cardiol. 2023;35(8). https://www.
hmpgloballearningnetwork.com/site/jic/article/7562
28. Kiernan TJ, Yan BP, Ruggiero N, et al. Coronary artery perforations
in the contemporary interventional era. J Interv Cardiol. 2009;22(4):
350‐353.
29. Teis‐Soley A, Fernández‐Nofrerías E, Rodríguez‐Leor O, et al.
Coronary artery perforation by intracoronary guidewires: risk factors
and clinical outcomes. Rev Esp Cardiol. 2010;63(6):730‐734.
30. Pershad A, Yarkoni A, Biglari D. Management of distal coronary
perforations. J Invasive Cardiol. 2008;20(6):187‐191.
1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ET AL.
31. Megaly M, Ali A, Saad M, et al. Outcomes with retrograde versus
antegrade chronic total occlusion revascularization. Catheter
Cardiovasc Interv. 2020;96(5):1037‐1043.
32. Danek BA, Karatasakis A, Karmpaliotis D, et al. Development and
validation of a scoring system for predicting periprocedural
complications during percutaneous coronary interventions of
chronic total occlusions: the prospective global registry for the
study of chronic total occlusion intervention (PROGRESS CTO)
complications score. J Am Heart Assoc. 2016;5(10):e004272.
33. Boukhris M, Tomasello SD, Azzarelli S, Elhadj ZI, Marzà F,
Galassi AR. Coronary perforation with tamponade successfully
managed by retrograde and antegrade coil embolization. J Saudi
Heart Assoc. 2015;27(3):216‐221.
34. Gasparini GL, Merella P, Mazzarotto P, Gagnor A, Garbo R,
Oreglia JA. Retrograde approach‐related epicardial collateral chan-
nel perforation successfully treated with simultaneous bilateral coils
embolization: a case illustration and reviewcardiovascular
revascularization. Cardiovasc Revascularizat Med. 2018;19(7):
879‐886.
35. Ahmed T, Chahal D, Shkullaku M, Gupta A. Extensive coil
embolization of a giant coronary artery aneurysm in an octogenar-
ian: a case report. European Heart J Case Rep. 2020;4:1‐5.
36. Pota P, Suwannasom P, Woragidpoonpol S, Srisuwan T. Coil
embolization to giant left anterior descending artery and left
circumflex artery coronary artery aneurysm after failed coronary
aneurysmal repair in IgG4‐related disease: a case report. Euro Heart
J Case Rep. 2021;5(11):ytab452.
37. Nakagawa T, Hara H, Wakiya M, Hiroi Y. Coil embolization for
ruptured coronary pseudoaneurysm causing haemopericardium: a
case report. Euro Heart J Case Rep. 2021;5(5):ytab129.
38. Kawsara A, Núñez Gil IJ, Alqahtani F, Moreland J, Rihal CS,
Alkhouli M. Management of coronary artery aneurysms. JACC.
2018;11(13):1211‐1223.
39. Sheikh A, Hailan A, Kinnaird T, Choudhury A, Smith D. Coronary
artery aneurysm: evaluation, prognosis, and proposed treatment
strategies. Heart Views. 2019;20(3):101.
40. Saccà S, Pacchioni A, Nikas D. Coil embolization for distal left main
aneurysm: a new approach to coronary artery aneurysm treatment.
Catheter Cardiovasc Interv. 2012;79(6):1000‐1003.
41. Abou Sherif S, et al. Coronary artery aneurysms: a review of the
epidemiology, pathophysiology, diagnosis, and treatment. Front
Cardiovasc Med. 2017;4:24.
42. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis,
treatment, and long‐term management of kawasaki disease: a
scientific statement for health professionals from the American
heart association. Circulation. 2017;135(17):e927‐e999.
43. Bavry AA, Chiu JH, Jefferson BK, et al. Development of coronary
aneurysm after drug‐eluting stent implantation. Ann Intern Med.
2007;146(3):230‐232.
44. Aoki J, Kirtane A, Leon MB, Dangas G. Coronary artery aneurysms
after drug‐eluting stent implantation. JACC. 2008;1(1):14‐21.
45. Yip H‐K, Chen MC, Wu CJ, et al. Clinical features and outcome of
coronary artery aneurysm in patients with acute myocardial
infarction undergoing a primary percutaneous coronary interven-
tion. Cardiology. 2002;98(3):132‐140.
46. Rath S, Har‐Zahav Y, Battler A, et al. Fate of nonobstructive
aneurysmatic coronary artery disease: angiographic and clinical
follow‐up report. Am Heart J. 1985;109(4):785‐791.
47. Ramirez FD, Hibbert B, Simard T, et al. Natural history and
management of aortocoronary saphenous vein graft aneurysms: a
systematic review of published cases. Circulation. 2012;126(18):
2248‐2256.
48. Bayturan Ö, et al. Endovascular coil treatment of a coronary artery
aneurysm related to polyarteritis nodosa. Anatol J Cardiol.
2017;18(5):370.

LOH ET AL.
49. Egred M, et al. Novel percutaneous closure of a left coronary artery
aneurysm. Heart. 2001;86:455.
50. Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary
artery fistulae: anatomy, diagnosis and management strategies.
Heart, Lung Circ. 2018;27(8):940‐951.
51. Vavuranakis M, Bush CA, Boudoulas H. Coronary artery fistulas in
adults: incidence, angiographic characteristics, natural history.
Cathet Cardiovasc Diagn. 1995;35(2):116‐120.
52. Jama A, Barsoum M, Bjarnason H, Holmes DR Jr, Rihal CS.
Percutaneous closure of congenital coronary artery fistulae: results
and angiographic follow‐up. JACC. 2011;4(7):814‐821.
53. Baumgartner H, De Backer J, Babu‐Narayan SV, et al. 2020 ESC
guidelines for the management of adult congenital heart disease. Eur
Heart J. 2021;42(6):563‐645.
54. Inglessis I, Landzberg MJ. Interventional catheterization in adult
congenital heart disease. Circulation. 2007;115(12):1622‐1633.
55. Seltzer S, Aboulhosn J, Levi DS. Use of interlock fibered detachable
coils for occlusion of collaterals, coronary artery fistulae, and patent
ductus arteriosus. Catheter Cardiovasc Interv. 2009;74(5):770‐776.
56. Perry SB, Radtke W, Fellows KE, Keane JF, Lock JE. Coil embolization to
occlude aortopulmonary collateral vessels and shunts in patients with
congenital heart disease. JACC. 1989;13(1):100‐108.
57. Sbarouni E, Corr L, Fenech A. Microcoil embolization of large
intercostal branches of internal mammary artery grafts. Cathet
Cardiovasc Diagn. 1994;31(4):334‐336.
58. Mangels D, Penny W, Reeves R. Left internal mammary artery side
branch intervention in the management of coronary steal syndrome
following coronary artery bypass grafting. Catheter Cardiovasc Interv.
2021;97(1):97‐104.
59. Nakhjavan FK, Koolpe HA, Bruss J, Najmi M, Radke T. Transcatheter
coil occlusion for treatment of left internal mammary‐anterior
descending artery steal phenomenon. Cathet Cardiovasc Diagn.
1993;28(4):347‐350.
60. Chavan A, Mügge A, Hohmann C, Amende I, Wahlers T, Galanski M.
Recurrent angina pectoris in patients with internal mammary artery
to coronary artery bypass: treatment with coil embolization of
unligated side branches. Radiology. 1996;200(2):433‐436.
61. Paelinck B, Kunnen J, den Branden FV, Vermeersch P. Transcatheter
embolization of a bronchial side branch of the internal mammary
artery for the treatment of a coronary steal phenomenon. Cathet
Cardiovasc Diagn. 1996;38(3):289‐291.
62. Soliotis F, Al‐Kutoubi A, Handler CE. Transbrachial coil occlusion of
the first intercostal branch of an internal mammary artery bypass
graft for angina. Int J Cardiol. 1997;59(2):206‐208.
63. Eisenhauer MD, Mego DM, Cambier PA. Coronary steal by IMA
bypass graft side‐branches: a novel therapeutic use of a new
detachable embolization coil. Cathet Cardiovasc Diagn. 1998;45(3):
301‐306.
64. Morocutti G, Gasparini D, Spedicato L, et al. Functional evaluation of
steal by unligated first intercostal branch before transcatheter
embolization in recurrent angina after a LIMA‐LAD graft. Catheter
Cardiovasc Interv. 2002;56(3):373‐376.
65. Ercan E, Tengiz I, Sekuri C, et al. Transbrachial coil occlusion of the
large branch of an internal mammary artery coronary graft. J Card
Surg. 2004;19(1):45‐46.
66. Lakkireddy DR, Lanspa TJ, Mehta NJ, Korlakunta HL, Khan IA.
Internal mammary artery steal syndrome secondary to an anomalous
lateral branch. Int J Cardiol. 2005;101(2):319‐322.
67. Akilli A, Duygu H, Erturk U, Yildiz A, Zoghi M, Ozerkan F.
Transbrachial coil occlusion of unligated thoracic side branch of
arterial graft of internal mammary artery leading to silent ischemia in
a diabetic patient. Int J Cardiol. 2006;113(1):E16‐E18.
68. Apitz C, Hoevelborn T, Beyer M, Sieverding L, Hofbeck M,
Gawaz MP. Transcatheter occlusion of a large intercostal sidebranch
1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 11
of left internal mammary artery bypass with detachable platinum
coils. Clinical research in cardiology. 2006;95(4):224‐227.
69. Mühlen C, Peter K, Spreer J, et al. Evidence of a steal phenomenon
by a thoracic side branch of an internal mammary artery bypass.
J Vasc Interv Radiol. 2006;17(10):1714‐1715.
70. Raval NY. Doppler evaluation and coil embolization of left internal
mammary artery bypass graft side branch. J Invas Cardiol.
2023;35(8). https://www.hmpgloballearningnetwork.com/site/jic/
articles/doppler-evaluation-and-coil-embolization-left-internal-
mammary-artery-bypass-graft-side
71. Kim ER, Oh SJ, Kang HJ, Kim KB. Post‐coronary artery bypass
grafting myocardial ischemia caused by an overgrown left internal
thoracic artery side branch. Korean J Thorac Cardiovasc Surg. 2014;
47(5):465‐467.
72. Berzingi C, Al Hajji M, Chaker Z, Alkhouli M. Reversal of
angiographic coronary steal with coil embolization of a large thoracic
internal mammary side branch. Euro Heart J Case Rep. 2018;2(2):
yty066.
73. Pagni S, Bousamra M, Shirley MW, Spence PA. Successful VATS
ligation of a large anomalous branch producing IMA steal syndrome
after MIDCAB. Ann Thorac Surg. 2001;71(5):1681‐1682.
74. Brilakis E. Manual of Percutaneous Coronary Interventions: A Step‐by‐
Step Approach. Academic Press; 2020.
75. Sadato A, Ogawa A, Taki W, et al. Modification of immediately
electrically detachable coil. Interv Neuroradiol. 1999;5(1_suppl):
215‐218.
76. Qureshi SA, Reidy JF, Alwi MB, et al. Use of interlocking detachable
coils in embolization of coronary arteriovenous fistulas. Am J Cardiol.
1996;78(1):110‐113.
77. Bendok BR, Rahme RJ. Complex shaped detachable platinum coil
system for the treatment of cerebral aneurysms: the codman trufill
DCS and trufill DCS orbit detachable coil system COMPLEX registry
final results. J NeuroIntervent Surg. 2013;5(1):54‐61.
78. Medsinge A, Zajko A, Orons P, Amesur N, Santos E. A case‐based
approach to common embolization agents used in vascular
interventional radiology. Am J Roentgenol. 2014;203(4):699‐708.
79. Makita K, Furui S, Irie T, et al. Embolization with steel coils using a
saline flush technique. Br J Radiol. 1991;64(764):708‐710.
80. Alekyan BG, Podzolkov VP, Cárdenas CE. Transcatheter coil
embolization of coronary artery fistula. Asian Cardiovasc Thorac
Ann. 2002;10(1):47‐52.
81. Shrestha BK, Arora D, Mehta Y, Bhan A. Coil migration after
endovascular closure of a coronary artery fistula. J Cardiothorac Vasc
Anesth. 2020;34(1):184‐186.
82. Eddleman CS, Welch BG, Vance AZ, et al. Endovascular coils:
properties, technical complications and salvage techniques.
J NeuroIntervent Surg. 2013;5(2):104‐109.
83. El‐Sabawi B, Al‐Hijji MA, Eleid MF, et al. Transcatheter closure of
coronary artery fistula: A 21‐year experience. Catheter Cardiovasc
Interv. 2020;96(2):311‐319.
84. Qureshi SA. Coronary arterial fistulas. Orphanet J Rare Dis.
2006;1(1):51.
85. Kabbani MR, Smith A, Leider M. Endovascular coil retrieval using a
TrevoProVue stentriever. J NeuroIntervent Surg. 2015;7(5):e19.
86. Kwon SC, Lyo IU, Shin SH, Park JB, Kim Y. Coil knotting during
endovascular coil embolization for ruptured MCA aneurysm: a case
report. Interv Neuroradiol. 2008;14(3):331‐334.
87. Abe T, Hirohata M, Tanaka N, et al. Coil migration, malposition,
stretching and retrieval. Interv Neuroradiol. 2000;6(1_suppl):
143‐147.
88. Doerfler A, Wanke I, Egelhof T, et al. Aneurysmal rupture during
embolization with Guglielmi detachable coils: causes, manage-
ment, and outcome. AJNR Am J Neuroradiol. 2001;22(10):
1825‐1832.
 1522726x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccd.30821 by CAPES, Wiley Online Library on [05/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
12 | LOH ET AL.

89. Orzalkiewicz M, Gunning M. Coronary artery fistula: recanalisation

after complete transcatheter coil occlusion. Heart. 2011;97(15): How to cite this article: Loh SX, Brilakis E, Gasparini G, et al.
1282.
Coils embolization use for coronary procedures: basics,
90. Cheung DLC, Au WK, Cheung HHC, Chiu CSW, Lee WT. Coronary
indications, and techniques. Catheter Cardiovasc Interv.
artery fistulas: long‐term results of surgical correction. Ann Thorac
Surg. 2001;71(1):190‐195. 2023;1‐12. doi:10.1002/ccd.30821