title: Early Rebleeding of Small Anterior Communicating Artery Aneurysm with Presumed Extrusion of Coil Loop to Outside the Aneurysmal Wall during Endovascular Treatment. A Report of Two Cases.
abstract: Although endovascular treatment has been proved to be as effective as surgical clipping in the prevention of rebleeding of ruptured aneurysm, early rebleeding after coil embolization has seldom been reported. We experienced early rehemorrhage in two patients of ruptured small anterior communicating artery aneurysms of complete treatment with coil-embolization initially. In both cases what interested us was not early rebleeding itself but how the presumed extrusion of the first part of coil loop beyond aneurysmal wall developed. However, there was no evidence of intraprocedural rupture and moreover complete occlusion with only one or two coils was obtained. Our two patients underwent successful second treatment. We discovered the presumed extruded first part of the coil loop initially was located inside the enlarged aneurysmal sac in retreatment stage. In case of coil embolization of ruptured small anterior communicating aneurysm, the phenomenon we experienced with no evidence of intraprocedural rupture in spite of obvious extrusion of coil loop beyond the aneurysmal wall can be a sign of necessity for early follow-up study including plain radiography to track the change in the presumed extruded coil loop.
authors.affiliation: Department of Radiology, College of Medicine, Inha University, Incheon, Korea - biganhoo@naver.com.
authors.forename: Hw
authors.initials: H
authors.lastname: Pyun
authors.forename: Dk
authors.initials: D
authors.lastname: Hyun
authors.forename: Dh
authors.initials: D
authors.lastname: Lee
authors.forename: Sw
authors.initials: S
authors.lastname: Park
authors.forename: Mk
authors.initials: M
authors.lastname: Lim
references.citation: Neuroradiology. 2008 May;50(5):423-7
references.pmid: 18283447
references.citation: Neurosurgery. 2005 Apr;56(4):785-92; discussion 785-92
references.pmid: 15792517
references.citation: AJNR Am J Neuroradiol. 2005 Sep;26(8):1916-20
references.pmid: 16155134
references.citation: AJNR Am J Neuroradiol. 2005 Aug;26(7):1739-43
references.pmid: 16091523
references.citation: Lancet. 2005 Sep 3-9;366(9488):809-17
references.pmid: 16139655
references.citation: Stroke. 2006 Jun;37(6):1437-42
references.pmid: 16627789
references.citation: J Neurosurg. 2008 Jun;108(6):1088-92
references.pmid: 18518708
references.citation: Neurosurg Rev. 2003 Oct;26(4):269-74
references.pmid: 12802695
references.citation: Surg Neurol. 2006 Nov;66(5):507-12
references.pmid: 17084199
references.citation: Neurosurg Rev. 2007 Apr;30(2):117-25; discussion 125-6
references.pmid: 17216530
references.citation: J Neurosurg. 2003 May;98(5):959-66
references.pmid: 12744354
references.citation: Neurosurgery. 2006 Oct;59(4):911-23; discussion 923-4
references.pmid: 17038956
references.citation: AJNR Am J Neuroradiol. 2005 Nov-Dec;26(10):2542-9
references.pmid: 16286399