瘤内塞栓術後早期に再増大をきたした破裂脳動脈瘤の2例

Abstract

We present two cases of ruptured large aneurysms that present regrowth and recanalization after Guglielmi detachable coil (GDC) treatment.The first patient, a 72-year-old woman, presented with subarachnoid hemorrhage (SAH) secondary to rupture of a 10-mm left internal carotid artery aneurysm with a 5-mm neck. The first GDC embolization was performed at 9 hours after onset, leaving contrast filling of the dome from the distal neck. Follow-up angiography 3 months later revealed aneurysmal regrowth, recanalization and coil compaction. A second embolization was performed, resulting in complete occlusion. However, follow-up angiography 9 months later revealed recanalization again. A third coiling was performed, resulting in complete occlusion. The second patient, a 53-year-old man, presented with SAH secondary to rupture of a 20-mm anterior communicating artery aneurysm with an 8-mm neck. GDC embolization was performed at 3 hours after onset, leaving a residual portion of the aneurysm neck. Ten months later, follow-up angiography demonstrated aneurysmal regrowth, recanalization and coil compaction. Repeat coiling was performed, resulting in residual neck filling. Both patients have lived normal daily lives without rebleedings.Because the large aneurysms with wide neck coiled with GDC have a tendency to regrowth and recanalize, close postoperative angiographic and clinical monitoring of patients with such aneurysms is necessary. If follow-up angiograms show coil compaction inside the aneurysm with re-exposure of portion of the aneurysm to the blood flow, further GDC treatment and/or a surgical approach should be considered.