COILSEAL: Use of Coils in Percutaneous Coronary Intervention, Useful for Complication Management?

The use of coils as vascular closing tool has been steadily expanding beyond its traditional role in neuroradiology into coronary territory, where it remains “off-label”. The COILSEAL, led by Cerrato et al., offers the first multicenter vision on hospital outcomes and mid-term followup of procedures using coils during coronary angioplasty. Data came from 17 high volume centers in Italy and Spain. 

The use of coils in coronary arteries presents two main indications: the first, and most common, is distal coronary perforation management, typically caused by inadvertent wire advancement into small or fragile territories, especially in the context of chronic total occlusions. These distal perforations are not treatable with coated stents and require precise occlusion strategy. The second indication is percutaneous closure of coronary aneurysms or fistulas, where coated stents can be technical or anatomically unfeasible. 

Technically speaking, coronary coiling is performed with micro catheters that allow positioning immediately above the point of extravasation and progressively deploying the coil until flow ceases completely. In the COILSEAL registry, the vast majority of devices were detachable coils (94%), because of their greater control during deployment. Instead, pushable coils were used exclusively in perforations and represented only 6% of cases.

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In coronary perforations, the average number of coils used per patient was 1.89 ± 0.87, with mean length 5.95 ± 3.72 cm and mean width 2.51 ± 0.90 mm. This choice of shorter length and smaller caliber responds to the need to occlude distant and frail segments without compromising side branches or inducing thrombotic propagation. 

The registry included 143 patients that needed coil implantation (0.06% of angioplasty procedures). 79% for perforations and 21% for aneurysms or fistulas. The cohort consisted of high risk patients, mean age 71, mostly men (71%) with high prevalence of multivessel disease and chronic occlusions.

The primary outcome was technical success, defined as absence of contrast extravasation at procedure end. Performance was remarkable, 95.7%, with no difference between perforations and aneurysms/fistulas. Procedural success (technical success with no major in-hospital clinical events) was lower for perforations (83.5% vs. 96.6%), which could be expected seeing the potential severity of this complication. Even so, in-hospital mortality was low, and the need for emergency surgery resulted exceptional (1.4%).

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At midterm followup (mean 2.4 years), the incidence of target vessel failure was 11.4%, with no significant differences between groups. There was higher rate of ischemia driven revascularization in cases of aneurysms or fistulas, consistent with the higher biological complexity of these lesions. Cardiac mortality remained low (4.9%) and the incidence of BARC major bleeding did not show significant differences. 

Conclusions

The COILSEAL registry outcomes have allowed us to concluded that the use of coils in the coronary setting is a safe, effective strategy with very high technical success rates, even in highly complex scenarios. Seeing its size and multicenter nature, this registry has contributed with robust scientific evidence to support a technique that, until now, had relied on small series and individual operator experience. 

Original Title: Contemporary Use of Coils During Percutaneous Coronary Intervention: Insights From the Multicenter COILSEAL Registry. 

Reference: Cerrato E, Piedimonte G, Franzino M, Marengo G, Bollati M, Zecchino S, Rutigliano D, Soriano F, Leoncini M, Mangione R, Sagazio E, Maiellaro F, Jeva F, Ussia GP, Scudiero F, Franzè A, Barbero U, Calderone D, Nicolino A, Ugo F, La Manna A, Costa F, Mazzarotto P, Amat-Santos IJ, Varbella F; CardioGroupVIII‐COILSEAL Study Group. Contemporary Use of Coils During Percutaneous Coronary Intervention: Insights From the Multicenter COILSEAL Registry. Catheter Cardiovasc Interv. 2025 Oct 21. doi: 10.1002/ccd.70233. Epub ahead of print. PMID: 41121637.