Coil-assist technique by using double microcatheters for a wide-necked ruptured anterior communicating artery aneurysm with a bleb arising from the neck

Abstract

Objective: We report a case of a wide-necked anterior communicating artery (Acom) aneurysm with a daughter sac (a bleb) arising from the neck, treated by the coil assist technique using double catheters.
Case presentation: A 75-year-old man developed disturbed consciousness while carrying a bottle of kerosene and chemical burns due to kerosene on the right side of his body, and he was taken by ambulance to our hospital. Head CT on admission revealed a subarachnoid hemorrhage with intracerebral hematoma (ICH) in the bilateral frontal lobes and the corpus callosum (World Federation of Neurological Societies grade III , Fischer group 4). Digital subtraction angiography revealed a wide-necked Acom aneurysm measuring 4.6 mm in the longer diameter with a 2.5 mm-sized daughter sac arising from the neck. The aneurysm sac as well as the daughter sac were embolized individually by the coil assist technique using double catheters. The postoperative course was uneventful, and a favorable clinical outcome was achieved.
Conclusion: Although coiling for the daughter sac of a ruptured aneurysm is not a recommended procedure, this technique appears to be effective for selected cases and can expand the indication of endovascular coiling for aneurysms with unfavorable morphology, such as a wide-necked aneurysm with a daughter sac originating from the neck.