Symptomatic delayed coil migration after balloon assisted embolization: An underreported adverse event?: An underreported adverse event?

espanolEl clipaje microquirurgico todavia se considera el tratamiento de eleccion para los aneurismas intracraneales de cuello ancho. Tecnicas de embolizacion asistida por balon o stent se han desarrollado para estas lesiones y muestran resultados prometedores. Como consecuencia, los aneurismas de cuello ancho se abordan cada vez mas mediante estas tecnicas, a pesar de que no existen ensayos controlados aleatorizados al respecto, y las complicaciones a largo plazo podrian ser desconocidas. La migracion intraprocedimiento de un coil esta bien documentada, pero la misma complicacion de forma tardia apenas esta descrita. Presentamos un caso de migracion tardia de un coil tras embolizacion asistida con balon de un aneurisma intracraneal de cuello ancho y revisamos la literatura para casos similares. Argumentamos que, a pesar de parecer una complicacion extremadamente rara, con la creciente percepcion de que las nuevas tecnicas endovasculares son la opcion mas segura en cualquier aneurisma, los potenciales eventos adversos pueden aumentar. Tambien revisamos las estrategias propuestas para abordar este nuevo escenario. EnglishMicrosurgical 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.