Introduction Distal coil migration during endovascular treatment of intracranial aneurysm occurs in 2∼6% of cases. As endovascular coil embolization of aneurysms has become popular, the incidence of intra-procedural coil migration increases. The consequences of coil migration vary significantly from asymptomatic to as severe as large territory cerebral infarction. However, delayed removal of migrated coil could leave a permanent neurological deficit.

Materials and methods Unintended coil migration occurred in 4(0.81%) patients among approximately 500 patients treated between Dec 2013 and Jul 2017 in Eulji university hospital. We report three cases of endovascular retrieval performed with snare technique and retrieval stent technique, and one case with microsurgical extraction. Surgical or endovascular removal of migrated coil is commonly used.

Results All 4 patients with coil migration were treated successfully immediately. For 2 cases, we used Amplatz Goose Neck Snare device to remove coil. And Solitare stent was used for retrieval and coil for 1 case was successfully removed. In last case, All endovascular retrieval technique failed and subarachnoid hemorrhage was combined. Due to emergent situation microsurgical craniotomy and arteriotomy was performed and migrated coil was removed. All patients recovered without any complication.

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Conclusion Migration of coil following embolization of an intracranial aneurysm is rare but can be a fatal complication. Recently the incidences and different results of management have been increasingly reported. In our institution, we performed three cases of endovascular retrieval and one case of surgical retrieval of migrated coil during endovascular coil embolization of intracranial aneurysm. In such urgent situation, operator should consider not only the retrieval of migrated coil but also the consequences following the event such as intracranial hemorrhage or cerebral infarction. Decision between surgical or endovascular retrieval of migrated coil should lead to avoid devastating consequences.

Disclosure S. Chung: None. S. Chang: None.