title: Rebleeding from a vertebral artery dissecting aneurysm after endovascular internal trapping: adverse effect of intrathecal urokinase injection or incomplete occlusion?-case report-.
abstract: A 67-year-old woman suffered rebleeding from a ruptured vertebral artery dissecting aneurysm after endovascular internal trapping. The dissecting aneurysm was initially successfully occluded with the affected vertebral artery using detachable coils. However, rebleeding from the aneurysm occurred on the next day. The rebleeding may have resulted from the thrombolytic effect of urokinase, which was injected intrathecally 3 hours before rebleeding occurred, or the relatively loose coil packing of the aneurysm. This case indicates the potential risk of intrathecal use of thrombolytic agents and the importance of complete tight coil packing of the whole dissected site in the treatment of ruptured vertebral artery dissecting aneurysms.
authors.affiliation: Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan. ksugiu@md.okayama-u.ac.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugiu
authors.forename: Koji
authors.initials: K
authors.lastname: Tokunaga
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ono
authors.forename: Ayumi
authors.initials: A
authors.lastname: Nishida
authors.forename: Isao
authors.initials: I
authors.lastname: Date
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007278:Injections, Spinal / Q000009:adverse effects; D020767:Intracranial Thrombosis / Q000188:drug therapy / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D055502:Secondary Prevention; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D020217:Vertebral Artery Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator