J Cerebrovasc Endovasc Neurosurg.  2015 Sep;17(3):246-251. 10.7461/jcen.2015.17.3.246.

Spontaneous Occluded Anterior Communicating Artery Aneurysm during Coil Embolization Treated with One Coil Insertion into Remaining Stump

• Chang SH
• Lee SH
• Shin HS
• Koh JS

• KMID: 2069251
• DOI: http://doi.org/10.7461/jcen.2015.17.3.246

Abstract

Spontaneous thrombosis of a ruptured aneurysm during coil embolization is a rare event, and some reports on recanalization of a spontaneous occluded ruptured aneurysm have been published. We report on a case of a 54-year-old male who presented with a subarachnoid hemorrhage due to rupture of a small aneurysm of the anterior communicating artery (ACoA). Cerebral angiography confirmed the presence of the ACoA aneurysm, but, during coil embolization, the aneurysm was near completely occluded with a remaining small neck. A small coil was inserted into the remaining stump of the neck to prevent recanalization, and the angiographic result at 1 year after coil embolization showed complete obliteration of the aneurysm.

Keyword

Intracranial aneurysm; Subarachnoid hemorrhage; Thrombosis; Recanalization

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Arteries
Cerebral Angiography
Embolization, Therapeutic*
Humans
Intracranial Aneurysm*
Male
Middle Aged
Neck
Rupture
Subarachnoid Hemorrhage
Thrombosis

Figure

• 

  Fig. 1 Axial brain CT scan taken on admission shows a subarachnoid hemorrhage on the anterior portion of the basal cistern. CT = computed tomography.

• 

  Fig. 2 Reconstruction of 3D rotational angiogram shows the dumbbell-shaped aneurysm with a very narrow neck (A). Measurement in each length of the aneurysm is 5.9 × 2.7 × 1.7 mm (width × height × neck diameter) (B).

• 

  Fig. 3 Neurointerventional images during coil embolization. At the moment of deploying the first coil, the tip of the microcatheter is seen to move back from the aneurysm and the projection of the coil loop outside the aneurysm is observed (A). After extraction of the coil, subsequent angiogram shows near obliteration of the aneurysm (B). Insertion of a smaller coil into the remaining stump of the neck is performed (C) and post-embolization angiogram shows complete occlusion of the aneurysm (D).

• 

  Fig. 4 Follow-up cerebral angiogram the next day showing persistent occlusion of the aneurysm (A, B).

• 

  Fig. 5 One-year follow-up cerebral angiogram (A, B). Despite change in the configuration of the coil, the aneurysm remains to be completely obliterated.

Reference

1. Black SP, German WJ. Observations on the relationship between the volume and the size of the orifice of experimental aneurysms. J Neurosurg. 1960; 11. 17:984–990. PMID: 20210035.

2. Bohmfalk GL, Story JL. Intermittent appearance of a ruptured cerebral aneurysm on sequential angiograms. Case report. J Neurosurg. 1980; 2. 52(2):263–265. PMID: 7351569.

3. Brownlee RD, Tranmer BI, Sevick RJ, Karmy G, Curry BJ. Spontaneous thrombosis of an unruptured anterior communicating artery aneurysm. An unusual cause of ischemic stroke. Stroke. 1995; 10. 26(10):1945–1949. PMID: 7570753.

4. Chohan MO, Westhout FD, Taylor CL. Delayed rebleeding of a spontaneously thrombosed aneurysm after subarachnoid hemorrhage. Surg Neurol Int. 2014; 3. 5:42. PMID: 24818049.

5. Choi YS, Kim DW, Jang SJ, Kang SD. Recanalization of completely thrombosed non-giant saccular aneurysm mimicking as de novo aneurysm. J Korean Neurosurg Soc. 2010; 10. 48(4):354–356. PMID: 21113364.

6. Cohen JE, Itshayek E, Gomori JM, Grigoriadis S, Raphaeli G, Spektor S, et al. Spontaneous thrombosis of cerebral aneurysms presenting with ischemic stroke. J Neurol Sci. 2007; 3. 254(1-2):95–98. PMID: 17258773.

7. Edner G, Forster DM, Steiner L, Bergvall U. Spontaneous healing of intracranial aneurysms after subarachnoid hemorrhage. Case report. J Neurosurg. 1978; 3. 48(3):450–454. PMID: 632868.

8. Fareed J, Walenga JM, Saravia GE, Moncada RM. Thrombogenic potential of nonionic contrast media? Radiology. 1990; 2. 174(2):321–325. PMID: 2296640.

9. Fodstad H, Liliequist B. Spontaneous thrombosis of ruptured intracranial aneurysms during treatment with tranexamic acid (AMCA). Report of three cases. Acta Neurochir (Wien). 1979; 49(3-4):129–144. PMID: 517175.

10. Golding R, Peatfield RC, Shawdon HH, Rice Edwards JM. Computer tomographic features of giant intracranial aneurysms. Clin Radiol. 1980; 1. 31(1):41–48. PMID: 7357825.

11. Jayakumar PN, Ravishankar S, Balasubramaya KS, Chavan R, Goyal G. Disappearing saccular intracranial aneurysms: do they really disappear? Interv Neuroradiol. 2007; 9. 13(3):247–254. PMID: 20566116.

12. Kim HJ, Kim JH, Kim DR, Kang HI. Thrombosis and recanalization of small saccular cerebral aneurysm : two case reports and a suggestion for possible mechanism. J Korean Neurosurg Soc. 2014; 5. 55(5):280–283. PMID: 25132936.

13. Lee KC, Joo JY, Lee KS, Shin YS. Recanalization of completely thrombosed giant aneurysm: case report. Surg Neurol. 1999; 1. 51(1):94–98. PMID: 9952130.

14. Mericle RA, Wakhloo AK, Lopes DK, Lanzino G, Guterman LR, Hopkins LN. Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. Case report. J Neurosurg. 1998; 7. 89(1):142–145. PMID: 9647186.

15. Nakajima Y, Yoshimine T, Mori H, Nakamuta K, Fujimura I, Sakashita K, et al. Spontaneous disappearance and reappearance of a ruptured cerebral aneurysm: one case found in a group of 33 consecutive patients with subarachnoid hemorrhage who underwent repeat angiography. Neurol Res. 2000; 9. 22(6):583–587. PMID: 11045020.

16. Nakau H, Nagatani H, Nakau R, Ametani T. Acute disappearance of ruptured aneurysm located near the origin of the superior cerebellar artery - case report. Neurol Med Chir (Tokyo). 2007; 10. 47(10):468–470. PMID: 17965564.

17. Spallone A, Peresedov VV, Kandel EI. Spontaneous cure of ruptured intracranial arterial aneurysms. Surg Neurol. 1981; 11. 16(5):367–370. PMID: 7336323.

18. Spetzler RF, Winestock D, Newton HT, Boldrey EB. Disappearance and reappearance of cerebral aneurysm in serial arteriograms. Case report. J Neurosurg. 1974; 10. 41(4):508–510. PMID: 4412837.

19. Su TM, Hsu SW, Chen WF, Lee TC, Cheng CH. Acute thrombosis and recanalization of a ruptured anterior communicating artery aneurysm. J Clin Neurosci. 2009; 8. 16(8):1077–1079. PMID: 19427789.

20. Szajner M, Jargiello T, Trojanowski T, Szczerbo-Trojanowska M. Spontaneous Thrombosis of the Pseudoaneurysm of Right SCA after an Attempt at Embolisation. A Case Report. Interv Neuroradiol. 2002; 6. 8(2):205–208. PMID: 20594531.

21. Valle EP, Tamargo RJ, Gailloud P. Thrombosis and subsequent recanalization of a ruptured intracranial aneurysm in 2 children, demonstrating the value of repeating catheter angiography after an initial negative study. J Neurosurg Pediatr. 2010; 4. 5(4):346–349. PMID: 20367338.

22. Wei D, Jingru Z, Cungang F, Yake X, Dongliang W, Zhengmao W, et al. Complete spontaneous thrombosis and recanalization of a ruptured posterior cerebral artery aneurysm. Turk Neurosurg. 2014; 24(3):406–410. PMID: 24848183.