B46-06 Rare Case of Coil Migration to the Bronchus and Esophagus After Ir Embolization of a Right Pulmonary Artery Pseudoaneruysm (PAP)

Abstract Introduction Endovascular coil embolization is widely used for pseudoaneurysms and other vascular lesions, yet coil migration is an uncommon but clinically significant late complication with potential airway involvement. Published reports describe migration across visceral and peripheral territories and within neurovascular beds, pointing to mechanisms such as incomplete reendothelialization, chronic mechanical stress at the deployment site, local infection or inflammation, and device-vessel mismatch.1-5 Concurrently, embolic technologies and biomaterials continue to evolve to improve conformability, stability, and durability.6-8 Case Presentation A 45-year-old male with a PMHx of PAP coil embolization for right upper thorax gunshot wound (GSW) was admitted for sepsis secondary to a wound infection. On imaging, a chest radiograph incidentally revealed metallic coil loops within the right upper thorax (Fig.1A). Further evaluation with coronal chest CT localized the coil material to the right bronchus and esophagus (Fig. 1B). After multidisciplinary discussion the patient was transferred to a tertiary care center and the decision was made for endoscopic procedure rather than complete surgical extraction due to substantial risk of hemorrhage, followed by monitoring migration, as the coil did not cause acute airway obstruction, bleed, or symptoms. Flexible bronchoscopy confirmed the presence of coils protruding into the bronchial lumen (Fig. 1C). Conclusion This case illustrates delayed endobronchial coil migration presenting as an airway foreign body, successfully managed with endoscopic clipping and extraction of visible coil components. Mechanistic contributors to migration include dynamic cardiopulmonary motion, local infection/inflammation, coil sizing relative to neck morphology, and inadequate anchoring within target anatomy.1-5 Advances in biomaterials and device design—spanning polymer chemistry and microstructure engineering—aim to improve frictional stability, conformability, and endothelial integration.6-8 Adherence to society guidance for patient selection, periprocedural planning, and surveillance is prudent.9-11 When intraluminal migration is symptomatic and anatomy is favorable, bronchoscopic retrieval in a controlled setting can be lung-sparing and may obviate thoracotomy. Early multidisciplinary evaluation enables tailored, safe management with excellent functional outcomes. This abstract is funded by: None