Repeated SAH from pseudoaneurysm after coil embolization. Case report

초록

PURPOSE : Endovascular treatment of ruptured intracranial aneurysm were increased. As cases of endovascular treatment were increased, many side effects or failures of treatment were reported. In addition we present surgical case of pseudoaneurysm induced after coil emolization and discuss plan to detect complication of endovascular treatment. MATERIALS AND METHODS : A 45-year-old man was admitted to emergency department due to sudden onset of headache during a rest. Brain computed tomography showed subarachnoid hemorrhage which were localizing interhemispheric area minimaly . Immediately, computed tomographic angiography was performed and ruptured anterior communicating aneurysm was confirmed. Endovascular treatment was chosen and coil embolization was done. Conventional angiography show coil to pack of ruptured aneurysm sac well , but small coil loop was positoned it hrough the aneurysmal wall as a packed ruptured site. During procedure, there were no leak of dye or blood. After 2 weeks later, the patient was discharged without problems. After one month, patient was developed sudden headache during coughing. Brain computed tomography showed subarachnoid hemorrhage which were localizing in corpus callosum and basal cistern. Rebleeding of coiled aneurysm was suspected but, CT angiogram and catheter angiogram can not shown aneurysmal sac on any site of circle of willis even though previous anterior communicating artery aneurysm site due to coil artifact. But plain X-ray shown coil loop shape change as like tail formation, so we decided exploration for proven to origin of SAH from a-com aneurysm. Introperatively, we found the pseudoaneurysm induced by coil tail and aneurismal neck clipping was done. The patient was discharged without complication after 3 weeks after operation. RESULTS : As a review of patient films, we missed coil shape changed after 10days later from endovascular treatment. A few cases of pseudoaneurysm were reported after coil embolization. A