J Korean Neurosurg Soc.  2008 Sep;44(3):178-181. 10.3340/jkns.2008.44.3.178.

Extravasation during Aneurysm Embolization without Neurologic Consequences. Lessons learned from Complications of Pseudoaneurysm Coiling. Report of 2 Cases

• Hue YH
• Yi HJ
• Kim YJ

• KMID: 2067352
• DOI: http://doi.org/10.3340/jkns.2008.44.3.178

Abstract

Although endovascular intervention is the first-line treatment of intracranial aneurysm, intraprocedural rupture or extravasation is still an endangering event. We describe two interesting cases of extravasation during embolotherapy for ruptured peripheral cerebral pseudoaneurysms. Two male patients were admitted after development of sudden headache with presentation of intracerebral and subarachnoid hemorrhage, respectively. Initial angiographic assessment failed to uncover any aneurysmal dilatation in both patients. Two weeks afterwards, catheter angiography revealed aneurysms each in the peripheral middle cerebral artery and anterior inferior cerebellar artery. Under a general anesthesia, endovascular embolization was attempted without systemic heparinization. In each case, sudden extravasation was noted around the aneurysm during manual injection of contrast after microcatheter navigation. Immediate computed tomographic scan showed a large amount of contrast collection within the brain, but they tolerated and made an unremarkable recovery thereafter. Intraprocedural extravasation is an endangering event and needs prompt management, however proximal plugging with coil deployment can be sufficient alternative, if one confronts with peripheral pseudoaneurysm. Peculiar angiographic features are deemed attributable to extremely fragile, porous vascular wall of the pseudoaneurysm. Accordingly, it should be noted that extreme caution being needed to handle such a friable vascular lesion.

Keyword

Endovascular embolization; Extravasation; Pseudoaneurysm

MeSH Terms

Anesthesia, General
Aneurysm
Aneurysm, False
Angiography
Arteries
Brain
Catheters
Dilatation
Embolization, Therapeutic
Headache
Heparin
Humans
Intracranial Aneurysm
Male
Middle Cerebral Artery
Rupture
Subarachnoid Hemorrhage
Heparin