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Aneurysmal Rupture during Embolization with Guglielmi Detachable Coils: Causes, Management, and Outcome

Arnd Doerflera, Isabel Wankea, Thomas Egelhofa, Uwe Dietricha, Siamak Asgaria, Dietmar Stolkea and Michael Forstinga

a From the Departments of Neuroradiology (A.D., I.W., T.E., U.D., M.F.) and Neurosurgery (S.A., D.S.), University of Essen Medical School, Germany.



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  		FIG 1. Case 1.

A, Lateral projection arteriogram of the left internal carotid artery reveals a posterior communicating artery aneurysm.

B, Lateral projection arteriogram of the left internal carotid artery, obtained immediately after aneurysm rupture that occurred after placement of the first coil, shows the rupture and massive extravasation of contrast material.

C, Selective angiogram obtained via the microcatheter.

D, Axial view CT scan obtained after clip placement in the aneurysm shows massive brain edema and contrast agent in the subarachnoid space.



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  		FIG 2. Case 2.

A, Frontal projection arteriogram of the left vertebral artery shows a basilar tip aneurysm.

B, Frontal projection arteriogram of the right vertebral artery, obtained after placement of two GDCs, reveals slight extravasation of contrast material (magnification).

C, Frontal projection arteriogram of the left vertebral artery shows complete embolization of the basilar artery tip aneurysm.

D, Axial view CT scan depicts slight extravasation of contrast agent and blood.



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  		FIG 3. Case 3.

A, Frontal projection arteriogram of the right internal carotid artery shows a small, caudally oriented anterior communicating artery aneurysm.

B and C, Arteriograms of the right internal carotid artery, obtained after placement of one GDC, show that the coil partially protrudes into the subarachnoid space.

D, Axial CT scan, obtained before endovascular treatment, shows SAH and extravasation of contrast material after aneurysm perforation.

E, Axial CT scan, obtained after endovascular treatment, shows SAH and extravasation of contrast material after aneurysmal perforation.

F, Control angiogram, obtained 4 wk after endovascular treatment, reveals the aneurysm remnant.



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  		FIG 4. Case 5.

A–C, Frontal projection arteriograms of the right internal carotid artery show an anterior communicating artery aneurysm before and after placement of three GDCs, with complete occlusion of the aneurysm.

D and E, Time-of-flight MR angiograms, obtained 2 d after endovascular treatment, confirm complete occlusion and do not reveal any thrombosed portions of the aneurysm.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X