Anterior Communicating Artery Aneurysm: Rupture with SAH, Endovascular Occlusion with Bare Coils, Early Re-rupture, Poor Clinical Outcome
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An 80-year-old female patient was referred with a spontaneous subarachnoid hemorrhage (SAH), graded as Hunt and Hess III, Fisher IV, with a thick clot along the course of the anterior cerebral artery (ACA). The SAH was due to a ruptured anterior communicating artery (AcomA) aneurysm. The irregularly contoured aneurysm was treated with coil occlusion with almost complete exclusion of the aneurysm from blood circulation. The presumed rupture site was identified and occluded with coils. However, the patient suffered an early re-hemorrhage 36 h after the coil treatment and deteriorated clinically. The site of the re-rupture was distinct from that of the first hemorrhage. The aneurysm was subsequently completely filled with further coils. The patient remained in a persistent vegetative state after the second hemorrhage and died three months after the endovascular treatment. Additional cases are also presented which illustrate early re-hemorrhage from the original rupture site. The rare event of an early re-hemorrhage after endovascular coil occlusion of a ruptured intracranial aneurysm is the main topic of this chapter.
KeywordsAcomA aneurysm SAH Coil occlusion Early re-hemorrhage
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