Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment

Case report

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✓ Guglielmi detachable coil (GDC) treatment for complicated cerebral aneurysms is an attractive option that has become widely accepted in recent years. This technique is usually considered only if the patient harbors an aneurysm that is not a good candidate for surgical clipping. However, the definition of “surgical candidate” varies among institutions, and many patients worldwide are being treated with GDCs as primary therapy. Although most centers currently perform follow-up angiography at 6 months to 1 year, others do not routinely perform it after an initially good result. The authors present a case that indicates longer follow up may be necessary and illustrates some of the pitfalls of GDC treatment.

This 56-year-old man presented to the emergency room with a Hunt and Hess Grade II subarachnoid hemorrhage and was found to have a wide-necked basilar apex aneurysm. Because of associated medical comorbidities, it was decided to treat the aneurysm with endovascular techniques. The patient did well on follow-up angiography at 1 year postprocedure. However, at approximately 2 years follow up, the aneurysm was demonstrated to have dramatically recanalized and regrown, requiring open surgical intervention.

Endovascular coiling was insufficient to treat this aneurysm and complicated definitive surgical management because a large coil mass had been placed in the operative field. It can be inferred from this case that angiographic follow up of these types of lesions may be beneficial up to 2 years after GDC treatment.

Article Information

Address reprint requests to: L. Nelson Hopkins, M.D., Neurosurgery, 3 Gates Circle, Buffalo, New York 14209.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Digital subtraction angiograms of a basilar apex aneurysm prior to interventions. Towne's (left) and lateral (right) projections demonstrate the wide neck and anatomy of the lesion.

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    Digital subtraction angiograms of the same area immediately after GDC treatment in two similar projections. The aneurysm appears approximately 95% occluded, based on the qualitative angiographic method used by previous authors.

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    Digital subtraction angiograms 1 year postprocedure in Towne's (left) and lateral (right) projections suggesting possible minimal loosening of the coil filaments in the proximal coil mass. The aneurysm is now approximately 90 to 95% occluded. These images did not prompt further intervention, other than scheduling repeat angiography after another year.

  • View in gallery

    Digital subtraction angiograms approximately 2 years postprocedure in Towne's (left) and lateral (right) projections. The images are enlarged to demonstrate the loose, unraveled loops of coils at the base of the aneurysm. This loosening and unraveling of coils with contrast material in the center of the coil mass suggests aneurysm regrowth, rather than simple recanalization.

  • View in gallery

    Postoperative digital subtraction angiograms immediately after surgical clipping in Towne's (left), lateral (center), and oblique (right) projections. The entire aneurysm cavity appears obliterated by the combination of the aneurysm clip and the coils.

References

  • 1.

    Aletich VADebrun GMMonsein LHet al: Giant serpentine aneurysms: a review and presentation of five cases. AJNR 16:106110721995Aletich VA Debrun GM Monsein LH et al: Giant serpentine aneurysms: a review and presentation of five cases. AJNR 16:1061–1072 1995

    • Search Google Scholar
    • Export Citation
  • 2.

    Borchers DJWakhloo AKGuterman LRet al: Long-term follow-up after GDC treatment of intracranial aneurysms: technical and hemodynamic considerations. J Neurosurg 84:334A1996 (Abstract)Borchers DJ Wakhloo AK Guterman LR et al: Long-term follow-up after GDC treatment of intracranial aneurysms: technical and hemodynamic considerations. J Neurosurg 84:334A 1996 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 3.

    Byrne JVAdams CBTKerr RSCet al: Endosaccular treatment of inoperable intracranial aneurysms with platinum coils. Br J Neurosurg 9:5855921995Byrne JV Adams CBT Kerr RSC et al: Endosaccular treatment of inoperable intracranial aneurysms with platinum coils. Br J Neurosurg 9:585–592 1995

    • Search Google Scholar
    • Export Citation
  • 4.

    Byrne JVHubbard NMorris JH: Endovascular coil occlusion of experimental aneurysms: Partial treatment does not prevent subsequent rupture. Neurol Res 16:4254271994Byrne JV Hubbard N Morris JH: Endovascular coil occlusion of experimental aneurysms: Partial treatment does not prevent subsequent rupture. Neurol Res 16:425–427 1994

    • Search Google Scholar
    • Export Citation
  • 5.

    Byrne JVMolyneux AJBrennan RPet al: Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 59:6166201995Byrne JV Molyneux AJ Brennan RP et al: Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 59:616–620 1995

    • Search Google Scholar
    • Export Citation
  • 6.

    Coleman RSifri-Steele C: Treatment of posterior circulation aneurysms using platinum coils. J Neurosci Nurs 26:3673701994Coleman R Sifri-Steele C: Treatment of posterior circulation aneurysms using platinum coils. J Neurosci Nurs 26:367–370 1994

    • Search Google Scholar
    • Export Citation
  • 7.

    Drake CGFriedman AHPeerless SJ: Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 61:8488561984Drake CG Friedman AH Peerless SJ: Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 61:848–856 1984

    • Search Google Scholar
    • Export Citation
  • 8.

    Drake CGVanderlinden RG: The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 27:2262381967Drake CG Vanderlinden RG: The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 27:226–238 1967

    • Search Google Scholar
    • Export Citation
  • 9.

    Fernandez Zubillaga AGuglielmi GViñuela Fet al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:8158201994Fernandez Zubillaga A Guglielmi G Viñuela F et al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815–820 1994

    • Search Google Scholar
    • Export Citation
  • 10.

    Feuerberg ILindquist CLindquist Met al: Natural history of postoperative aneurysm rests. J Neurosurg 66:30341987Feuerberg I Lindquist C Lindquist M et al: Natural history of postoperative aneurysm rests. J Neurosurg 66:30–34 1987

    • Search Google Scholar
    • Export Citation
  • 11.

    Fisher CMKistler JPDavis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:191980Fisher CM Kistler JP Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    Gaston ADeck PBrugieres Pet al: Endovascular treatment of subarachnoid arterial aneurysms in the acute period. Preliminary results. J Neuroradiol 19:2362471992Gaston A Deck P Brugieres P et al: Endovascular treatment of subarachnoid arterial aneurysms in the acute period. Preliminary results. J Neuroradiol 19:236–247 1992

    • Search Google Scholar
    • Export Citation
  • 13.

    Gobin YPViñuela FGurian JHet al: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:55621996Gobin YP Viñuela F Gurian JH et al: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:55–62 1996

    • Search Google Scholar
    • Export Citation
  • 14.

    Graves VBStrother CMDuff TAet al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:6406481995Graves VB Strother CM Duff TA et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:640–648 1995

    • Search Google Scholar
    • Export Citation
  • 15.

    Guglielmi GViñuela FDion Jet al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2. Preliminary clinical experience. J Neurosurg 75:8141991Guglielmi G Viñuela F Dion J et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2. Preliminary clinical experience. J Neurosurg 75:8–14 1991

    • Search Google Scholar
    • Export Citation
  • 16.

    Guglielmi GViñuela FDuckwiler Get al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:5155241992Guglielmi G Viñuela F Duckwiler G et al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515–524 1992

    • Search Google Scholar
    • Export Citation
  • 17.

    Halbach VVHigashida RTDowd CFet al: Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79:1831911993Halbach VV Higashida RT Dowd CF et al: Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79:183–191 1993

    • Search Google Scholar
    • Export Citation
  • 18.

    Hunt WEHess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14191968Hunt WE Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–19 1968

    • Search Google Scholar
    • Export Citation
  • 19.

    Komiyama MYasui TNishikawa M: Endovascular treatment of an extracranial internal carotid artery aneurysm at the skull base with mechanically detachable coils—case report. Neurol Med Chir 35:7457481995Komiyama M Yasui T Nishikawa M: Endovascular treatment of an extracranial internal carotid artery aneurysm at the skull base with mechanically detachable coils—case report. Neurol Med Chir 35:745–748 1995

    • Search Google Scholar
    • Export Citation
  • 20.

    Kurokawa YAbiko SOkamura Tet al: Direct surgery for giant aneurysm exhibiting progressive enlargement after intraaneurysmal balloon embolization. Surg Neurol 38:19251992Kurokawa Y Abiko S Okamura T et al: Direct surgery for giant aneurysm exhibiting progressive enlargement after intraaneurysmal balloon embolization. Surg Neurol 38:19–25 1992

    • Search Google Scholar
    • Export Citation
  • 21.

    Lane BMarks MP: Coil embolization of an acutely ruptured saccular aneurysm. AJNR 12:106710691991Lane B Marks MP: Coil embolization of an acutely ruptured saccular aneurysm. AJNR 12:1067–1069 1991

    • Search Google Scholar
    • Export Citation
  • 22.

    Lin TFox AJDrake CG: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:5565601989Lin T Fox AJ Drake CG: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556–560 1989

    • Search Google Scholar
    • Export Citation
  • 23.

    Mawad MEKlucznik RP: Giant serpentine aneurysms: radiographic features and endovascular treatment. AJNR 16:105310601995Mawad ME Klucznik RP: Giant serpentine aneurysms: radiographic features and endovascular treatment. AJNR 16:1053–1060 1995

    • Search Google Scholar
    • Export Citation
  • 24.

    McDougall CGHalbach VVDowd CFet al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:3933991996McDougall CG Halbach VV Dowd CF et al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:393–399 1996

    • Search Google Scholar
    • Export Citation
  • 25.

    Nakahara IHanda HNishikawa Met al: Endovascular coil embolization of a recurrent giant internal carotid artery aneurysm via the posterior communicating artery after cervical carotid ligation: case report. Surg Neurol 38:57621992Nakahara I Handa H Nishikawa M et al: Endovascular coil embolization of a recurrent giant internal carotid artery aneurysm via the posterior communicating artery after cervical carotid ligation: case report. Surg Neurol 38:57–62 1992

    • Search Google Scholar
    • Export Citation
  • 26.

    Nichols DA: Endovascular treatment of the acutely ruptured intracranial aneurysm. J Neurosurg 79:121993Nichols DA: Endovascular treatment of the acutely ruptured intracranial aneurysm. J Neurosurg 79:1–2 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    Polin RSShaffrey MEJensen MEet al: Medical management in the endovascular treatment of carotid-cavernous aneurysms. J Neurosurg 84:7557611996Polin RS Shaffrey ME Jensen ME et al: Medical management in the endovascular treatment of carotid-cavernous aneurysms. J Neurosurg 84:755–761 1996

    • Search Google Scholar
    • Export Citation
  • 28.

    Strother CMLunde SGraves Vet al: Late paraophthalmic aneurysm rupture following endovascular treatment. Case report. J Neurosurg 71:7777801989Strother CM Lunde S Graves V et al: Late paraophthalmic aneurysm rupture following endovascular treatment. Case report. J Neurosurg 71:777–780 1989

    • Search Google Scholar
    • Export Citation
  • 29.

    Szikora IWakhloo AKGuterman LRet al: Initial experience with collagen-filled Guglielmi detachable coils for endovascular treatment of experimental aneurysms. AJNR 18:6676721997Szikora I Wakhloo AK Guterman LR et al: Initial experience with collagen-filled Guglielmi detachable coils for endovascular treatment of experimental aneurysms. AJNR 18:667–672 1997

    • Search Google Scholar
    • Export Citation
  • 30.

    Taki WNishi SYamashita Ket al: Selection and combination of various endovascular techniques in the treatment of giant aneurysms. J Neurosurg 77:37421992Taki W Nishi S Yamashita K et al: Selection and combination of various endovascular techniques in the treatment of giant aneurysms. J Neurosurg 77:37–42 1992

    • Search Google Scholar
    • Export Citation
  • 31.

    Uemura KSonobe MAkai Tet al: Early endovascular treatment for ruptured basilar bifurcation aneurysm—case report. Neurol Med Chir 35:3143161995Uemura K Sonobe M Akai T et al: Early endovascular treatment for ruptured basilar bifurcation aneurysm—case report. Neurol Med Chir 35:314–316 1995

    • Search Google Scholar
    • Export Citation

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