Case report
Delayed rupture of a basilar artery aneurysm treated with coils: Case report and review of the literature

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Summary

Delayed rupture of a previously unruptured cerebral aneurysm after uneventful saccular coil packing is rare, particularly when the quality of aneurysm occlusion is appropriate (neck remnant or total occlusion). The present report describes the case of a 70-year-old woman with an incidentally detected, asymptomatic, small basilar tip non-thrombosed aneurysm who experienced rupture of the aneurysm 2 years after coiling. Cerebral angiography taken on the day of rupture revealed only small recanalization of the aneurysm neck with no dome-filling. This is the first report of delayed rupture due to minor recurrence of a previously unruptured small asymptomatic cerebral aneurysm after saccular coil packing. A literature review of 26 reports of late bleeding after coil embolization of previously unruptured cerebral aneurysms showed that dome-filling after coil embolization, symptomatic aneurysms and large/giant aneurysms all increase the risk of delayed rupture in previously unruptured aneurysms after saccular coil packing.

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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      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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