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Original research
Rupture of aneurysms in the immediate post-coiling period
  1. Adam Andrew Dmytriw1,
  2. Gwynedd Elaine Pickett2,
  3. Jai J S Shankar3
  1. 1Dalhousie University, Halifax, Canada
  2. 2Department of Neurosurgery, QEII Health Sciences Centre, Halifax, Canada
  3. 3Division of Neuroradiology, Department of Diagnostic Imaging, QEII Health Sciences Centre, Halifax
  1. Correspondence to Dr Jai J S Shankar, Division of Neuroradiology, Department of Diagnostic Imaging, QEII Health Sciences Centre, Room 3305A, Halifax Infirmary, 1796 Summer Street, Halifax, NS, Canada B3H 3A7; shivajai1{at}gmail.com

Abstract

Purpose We present a series of cases featuring re-rupture of posterior communicating artery aneurysms in the immediate post-coiling period, where 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 ≤3 days following the procedure.

Results The incidence of re-rupture in the immediate post-coiling period was 1.4% (2/137). Of these two, one received recombinant tissue plasminogen activator and both received acetylsalicylic acid. One patient presented with adjacent hematoma on re-rupture. In both cases, clot obscured the aneurysm neck during the procedure.

Conclusions 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 length. Repeat treatment, follow-up imaging and close observation are merited in the setting of re-rupture of a posterior communicating artery aneurysm.

  • Aneurysm
  • Coil
  • Complication
  • Hemorrhage
  • Thrombolysis

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