Case reportDelayed rupture of a basilar artery aneurysm treated with coils: Case report and review of the literature
Introduction
The efficacy of endovascular coil embolization in the management of unruptured cerebral aneurysms has been characterized in several large studies [1], [2], and delayed rupture of a previously unruptured cerebral aneurysm after uneventful saccular coil packing is a rare event [3], [4].
Section snippets
Case report
A 70-year-old woman was incidentally diagnosed with an asymptomatic basilar tip aneurysm on magnetic resonance imaging (Fig. 1) and magnetic resonance angiography (MRA). Her history was notable for hypertension, hyperlipidemia and coronary artery disease (treated with aspirin 100 mg daily), but she had no history of subarachnoid hemorrhage. Transarterial coil embolization of this unruptured basilar tip aneurysm (diameter: 7.4 mm; Fig. 2 A–D) was performed, and 95% neck-remnant occlusion of the
Delayed rupture after saccular coiling
In the published literature, there are 26 reports of late bleeding after coil embolization of previously unruptured aneurysms (Table 1) [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]. Ten were symptomatic and only one was asymptomatic at the time of initial presentation. In the other 15 cases, the presence or absence of symptoms was not reported. However, two of these 15 cases developed new compressive symptoms in the postoperative follow-up
Conclusion
The risk of bleeding of a minor recurrence of a previously unruptured cerebral aneurysm after saccular coil packing is extremely low. The presence of dome-filling after coil embolization, symptomatic aneurysms and large/giant aneurysms all increase the risk of delayed rupture in such coil-packed, previously unruptured aneurysms at usually more than 3 months after coil embolization.
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgments
The authors thank Dr. Tatsuo Takahashi, Dr. Motoki Oheda, Dr. Yosuke Tamari, Dr. Tetsuya Tsukada, and Dr. Takayuki Awaya (Department of Neurosurgery, Nagoya Medical Center) for their helpful discussion.
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Delayed Bleeding of Unruptured Intracranial Aneurysms After Coil Embolization: A Retrospective Case Series
2021, World NeurosurgeryCitation Excerpt :The long-term efficacy of endovascular coiling for UIAs for the prevention of rupture has been reported.4,5,9,10 However, there are some case reports on the incidence of delayed bleeding of UIAs after coil embolization, and delayed bleeding has not been sufficiently evaluated.11-15 Hence the present study aimed to analyze the occurrence of delayed bleeding of UIAs after coil embolization.
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