This report details the successful microsurgical removal of a migrated coil and an embolectomy of the middle cerebral artery (MCA). During endovascular occlusion of a giant carotid artery aneurysm, a detached coil at the neck of the aneurysm migrated up into the MCA and could not be removed with a retriever. Acute occlusion of the anterior cerebral artery and MCA caused progressive neurological deterioration, and an emergency microsurgical embolectomy was performed, which led to a good postoperative neurological outcome. However, angiographical follow-up after 1 year demonstrated marked compaction of the coils and recanalization of the giant aneurysm, which requires additional treatment.