Purpose We present a series of cases featuring re-rupture of posterior communicating aneurysm in the immediate post-coiling period, wherein clots obscured the neck of the aneurysm during the procedure. We report on the incidence of re-rupture, and discuss possible mechanisms behind this phenomenon.
Methods This study included 462 aneurysms over a 10-year period, which were treated with endovascular coiling. 137 of these were ruptured aneurysms. Radiographic and clinical information pertaining to the patients was collected. The immediate post-coiling period was defined as three days or fewer following the procedure.
Results The incidence of re-rupture in the immediate post-coiling period was 1.4% (2 in 137). Of these two, one received rtPA and both received ASA. One patient presented with adjacent haematoma on re-rupture. In both cases, clot obscured the aneurysm neck during the procedure.
Conclusion Re-rupture of intracranial aneurysms in the immediate post-coiling period is an exceedingly rare complication, and the events leading to it have not been discussed at any length. Repeat treatment, follow-up imaging and close observation are merited in the setting of re-rupture of a posterior communicating aneurysm.
Disclosures A. Dmytriw: None. G. Pickett: None. J. Shankar: None.
Drake CG, Friedman AH, Peerless SJ. Failed Aneurysm Surgery - Reoperation in 115 Cases. J Neurosurg 1984;61 (5):848–56.
Bederson. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association (vol 40, pg 994, 2009). Stroke 2009;40 (7):E518-E18.
Sluzewski M, van Rooij WJ. Early rebleeding after coiling of ruptured cerebral aneurysms: Incidence, morbidity, and risk factors. Am J Neuroradiol 2005;26 (7):1739–43.
Cho YD, Lee JY, Seo JH, Kang HS, Kim JE, Kwon OK, et al. Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms. Neuroradiology 2012;54 (7):719–26.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.