title: [A Case of Brainstem Hemorrhage Following Embolization of a Large Basilar Aneurysm with Hydrogel-Coated Coils].
abstract: OBJECTIVE
  Endovascular coil embolization of intracranial aneurysms is associated with better outcomes and a lower mortality rate compared with surgical clip occlusion. However, a principal disadvantage of endovascular therapy is the higher rate of retreatment compared with neurosurgical clipping. Self-expandable hydrogel-coated coils were developed to reduce recanalization rates of cerebral aneurysms by promoting complete volumetric aneurysm occlusion. Herein, we report a case of brainstem hemorrhage following coil embolization of a large basilar aneurysm with hydrogel-coated coils.
  
  
  METHODS
  A 65-year-old female with a history of hypertension, who presented with worsening headaches, right hemiplegia, and left oculomotor palsy, underwent endovascular treatment for a large basilar aneurysm. The aneurysm was treated with both hydrogel-coated coils and bare platinum coils. Hydrogel-coated coils represented 46% of the coil length in the aneurysm. The patient was discharged from the hospital with improvement of neurological deficits 6 days after the procedure. However, the patient was readmitted with perianeurysmal edema in the midbrain 23 days after coil embolization. Follow-up angiography 26 days after the procedure showed complete obliteration of the aneurysm. Two weeks later, the patient presented with a large brainstem hemorrhage and died. Pathological findings revealed intraparenchymal hemorrhage in the pons without rupture of the aneurysm.
  
  
  CONCLUSIONS
  Hydrogel-coated coils may cause a marked inflammatory response that may result in intracerebral hemorrhage.
authors: Department of Neurosurgery, Kawaguchi Municipal Medical Center.
authors: Makoto
authors: M
authors: Furuichi
authors: Kentaro
authors: K
authors: Shimoda
authors: Toshikazu
authors: T
authors: Kano
authors: Shoshi
authors: S
authors: Satoh
authors: Atsuo
authors: A
authors: Yoshino
mesh_terms: D000368:Aged; D001933:Brain Stem; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000009:adverse effects; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D016896:Treatment Outcome
chemical_list: D020136:Hydrogel, Polyethylene Glycol Dimethacrylate