J Cerebrovasc Endovasc Neurosurg.  2012 Jun;14(2):95-98. 10.7461/jcen.2012.14.2.95.

Delayed Symptomatic Thromboembolism After Unruptured Middle Cerebral Artery Aneurysm Embolization

• Kim HJ
• Lee TJ
• Lee SI
• Jin SC

• KMID: 1808443
• DOI: http://doi.org/10.7461/jcen.2012.14.2.95

Abstract

Endovascular treatment has been increasingly performed for unruptured intracerebral aneurysms. However, thromboembolic complications, which develop mostly within 48 hours after the procedure, are the most common and major complications of endovascular treatment. We present a rare case of delayed symptomatic thromboembolism in an ischemic stroke patient who had undergone coil embolization for unruptured middle cerebral artery (MCA) aneurysm.

Keyword

Endovascular treatment; Cerebral aneurysm; Thromboembolism

MeSH Terms

Aneurysm
Humans
Intracranial Aneurysm
Middle Cerebral Artery
Stroke
Thromboembolism

Figure

• 

  Fig. 1 Initial MRI shows acute ischemic lesions in the right thalamus on a diffusion weighted image (DWI) (A). An angiogram shows a 6.4 mm sized saccular aneurysm with a wide neck (B). Working projection views reveal partial coil embolization of the left middle cerebral artery (MCA) (C, D). 19 days later, sensory aphasia and right arm weakness developed. The DWI reveals some scattered infarction in the territory of the distal part of the embolized vessels (E) and the angiogram shows a filling defect as a thrombus in the aneurysm just distal to them (F). Control angiogram after intra-arterial thrombolysis showed complete resolution of thrombus and contrast filling of the coiled aneurysm sac (G).

Reference

1. Derdeyn CP, Cross DT 3rd, Moran CJ, Brown GW, Pilgram TK, Diringer MN, et al. Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg. 2002. 05. 96(5):837–843.

2. Haraguchi K, Houkin K, Nonaka T, Baba T. Delayed thromboembolic infarction associated with reconfiguration of Guglielmi detachable coils--case report. Neurol Med Chir (Tokyo). 2007. 02. 47(2):79–82.

3. Hwang G, Jung C, Park SQ, Kang HS, Lee SH, Oh CW, et al. Thromboembolic complications of elective coil embolization of unruptured aneurysms: the effect of oral antiplatelet preparation on periprocedural thromboembolic complication. Neurosurgery. 2010. 09. 67(3):743–748. discussion 748.

4. Lenthall RK, McConachie NS, Jaspan T. Delayed reconfiguration of a Guglielmi detachable coil mass associated with late occlusion of an adjacent aneurysm and parent vessel. AJNR Am J Neuroradiol. 2000. Nov-Dec. 21(10):1908–1910.

5. Rordorf G, Bellon RJ, Budzik RE Jr, Farkas J, Reinking GF, Pergolizzi RS, et al. Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion-weighted imaging. AJNR Am J Neuroradiol. 2001. 01. 22(1):5–10.

6. Soeda A, Sakai N, Sakai H, Iihara K, Yamada N, Imakita S, et al. Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2003. 01. 24(1):127–132.

7. Studley MT, Robinson DH, Howe JF. Delayed thromboembolic events 9 weeks after endovascular treatment of an anterior communicating artery aneurysm: case report. AJNR Am J Neuroradiol. 2002. Jun-Jul. 23(6):975–977.

8. Vinuela F, Duckwiler G, Mawad M. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg. 1997. 03. 86(3):475–482.

9. Yamada NK, Cross DT 3rd, Pilgram TK, Moran CJ, Derdeyn CP, Dacey RG Jr. Effect of antiplatelet therapy on thromboembolic complications of elective coil embolization of cerebral aneurysms. AJNR Am J Neuroradiol. 2007. 10. 28(9):1778–1782.