Early Treatment of Pseudo-Sac Formation in a Thrombotic Cavity at the Aneurysm Rupture Site

Choi, Yul; Jang, Suk Jung

Abstract

The authors report on an endovascular experience using electrically detachable coils and direct clipping for the treatment of ruptured irregularly shaped aneurysms associated with pseudo-sac formation in a thrombotic cavity at the rupture site. These aneurysms might be fragile and associated with a high possibility of repeated rupture, especially, during an endovascular and direct clipping procedures. Between March 1998 and August 2001, 298 aneurysm patients underwent operations at our hospital. Among these patients, 4 patients showed pseudo-sac formation in a thrombotic cavity at the aneurysm rupture site, and were treated using an early endovascular occlusion technique or direct clipping after diagnostic angiography. These aneurysms showed delayed opacification and delayed washout of contrast medium from the irregularly shaped portion of the aneurysm on digital subtraction angiography. Moreover these aneurysms tend to rerupture during GDC embolization because of the fragile pseudoaneurysmal thrombotic cavity at the rupture point. Ruptured aneurysm with pseudo-sac formation in thrombotic cavity display delayed and irregularly shaped filling and retention of contrast medium at the rupture point. Early treatment of these aneurysms prevents rebleeding from the pseudo-sac in the thrombotic cavity at the ruptured site.