Delayed rupture of a previously coiled unruptured anterior communicating artery aneurysm: case report.
OBJECTIVE
We describe a case of an unruptured anterior communicating aneurysm that was treated successfully with Guglielmi detachable coils, which subsequently ruptured 23 months after initial therapy. This report discusses only the second published case of an unruptured lesion that was well embolized (>95% occlusion) and stable at 6-month angiographic follow-up that ruptured in a delayed fashion almost 2 years after the primary procedure.


METHODS
An 80-year-old man presented in Hunt and Hess Grade IV as a result of a ruptured anterior communicating artery aneurysm. The patient had undergone endovascular therapy 23 months earlier with documented nearly complete (1-mm residual neck) occlusion at 0 and 6 months.


METHODS
The patient underwent diagnostic catheter angiography at the time of admission, which revealed a 10-mm aneurysm adjacent to the previously embolized lesion. No further therapy was administered, and the patient died within 24 hours as a result of ictus. The request for an autopsy was denied.


CONCLUSIONS
Aneurysm rupture after Guglielmi detachable coil embolization is a rare event. Most cases involve previously ruptured lesions. To the best of our knowledge, only one previous case of delayed rupture of an unruptured aneurysm that was managed endovascularly has been published in the English-language literature. This second case points to the need for vigilance in the follow-up of patients with coiled lesions.
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA. horowitz@neuronet.pitt.edu
Michael B
MB
Horowitz
Charles A
CA
Jungreis
Julie
J
Genevro
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D017809:Fatal Outcome; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D013997:Time Factors