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Case Report
DOI: 10.1016/j.neucir.2018.02.005
Symptomatic delayed coil migration after balloon assisted embolization: An underreported adverse event?
Migración Sintomática Tardía de Coil tras Embolización Asistida con Balón: ¿un evento adverso infra descrito?
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Lino Fonsecaa,1, Rafael Najarro-Quispeb,1, Ana Rodríguez-Hernándezb,
Corresponding author
ana.neurosurgery@hotmail.com

Corresponding author.
, Ramon Tornéc, Dario Gándara-Sabatinib, Fuat Arikanb,d, Pilar Baños-Carrascob
a Department of Neurological Surgery, Centro Hospitalar Lisboa Central – Hospital São José, Lisbon, Portugal
b Department of Neurological Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
c Department of Neurological Surgery, Clinic Hospital, Barcelona, Spain
d Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d’Hebron Research Institute, Universitat Autonoma de Barcelona (UAB), Spain
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Received 06 November 2017, Accepted 18 February 2018
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Table 1. Summary of clinical features of 15 cases of delayed coil migration.
Abstract

Microsurgical clipping is still regarded as the gold-standard treatment for broad-neck intracranial aneurysms. New endovascular techniques like balloon or stent assisted coiling are quickly rising to the challenge and showing promising outcomes. As a result, broad-neck aneurysms are increasingly addressed by these techniques despite they have not been tested against clipping in a randomized controlled trial and long-term complications might be unknown yet. Intraprocedural coil migration has been well documented in the literature, but the same complication in a delayed fashion is scarcely reported. We present a case of delayed coil migration occurring after a balloon-assisted embolization of a wide-necked intracranial aneurysm and we perform a literature review for similar cases. We discuss how, despite seeming an extremely rare complication, with new endovascular techniques increasingly perceived as the safer option in any aneurysm, potential adverse events may become more frequent. Strategies proposed to address this developing scenario are also reviewed.

Keywords:
Broad-neck aneurysm
Balloon assisted coiling
Stent assisted coiling
Adverse event
Coil migration
Resumen

El clipaje microquirúrgico todavía se considera el tratamiento de elección para los aneurismas intracraneales de cuello ancho. Técnicas de embolización asistida por balón o stent se han desarrollado para estas lesiones y muestran resultados prometedores. Como consecuencia, los aneurismas de cuello ancho se abordan cada vez más mediante estas técnicas, a pesar de que no existen ensayos controlados aleatorizados al respecto, y las complicaciones a largo plazo podrían ser desconocidas. La migración intraprocedimiento de un coil está bien documentada, pero la misma complicación de forma tardía apenas está descrita. Presentamos un caso de migración tardía de un coil tras embolización asistida con balón de un aneurisma intracraneal de cuello ancho y revisamos la literatura para casos similares. Argumentamos que, a pesar de parecer una complicación extremadamente rara, con la creciente percepción de que las nuevas técnicas endovasculares son la opción más segura en cualquier aneurisma, los potenciales eventos adversos pueden aumentar. También revisamos las estrategias propuestas para abordar este nuevo escenario.

Palabras clave:
Aneurismas de cuello ancho
Embolización asistida por balón
Stent asistido
Eventos adversos
Migración de coil

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