뇌동맥류 코일색전술후 발생한 코일 스트레칭의 치료; 증례

초록

PURPOSE : Coil embolization is safe treatment for cerebral aneurysm, however it can be occurred also unsatisfactory periprocedual complication. There were highly morbidity and mortality expected in case of coil stretching. So we report our unusual experience of coil stretching during coil embolization in aneurysmal subarachnoid hemorrhage(SAH). MATERIALS AND METHODS : Case 1) A 63-aged man was admitted our hospital because of spontaneous SAH due to anterior communicating artery aneurysmal rupture. We were chosen coil embolization. After packing of first selected coil(Ultrasoft, 4x30, Cordis), anterior communicating artery obliteration was noted. So, we decided coil withdrawal, but we fail to remove due to resistance. We decided to operation. During operation, successfully removed intra-aneurysmal stretched coil with piece-meal pattern. Case 2) A 65-year-old woman presented SAH in basal cistern due to left anterior choroidal aneurysm rupture. A coil embolization with stent assisted method to the lesion was performed. Grossly, the aneurysm was seen large wide-neck (neck : 5,7mm depth : 12mm). We use the Cordis-miniCx-02.5x4.5 as last coil, but it stretched out. We reposition the stretched two coils from internal carotid artery(ICA) to external carotid artery(ECA) side. She was stable and does not change neurologically during procedure. RESULTS : After the operations, two patients did not show any neurological deterioration, and progressively improved symptoms. It need to follow up some of days. CONCLUSION : In this case, we introduce the possibility of stretched coil during embolization of cerebral aneurysm. We must do careful management of microcatheter and coil during procedure. In case of coil stretching, we recommend to stop procedure, and consider coil removal or reposition to ECA. It should also be followed early cerebral angiography.