Abstract
Objective: In the treatment of coil embolization for cerebral aneurysms, follow-up imaging study is recommended because recurrence occurs in 10–20%. We report a valuable case in which an unruptured aneurysm treated with coil embolization was followed-up by periodic magnetic resonance angiography (MRA) and ruptured 6 years after coil embolization.
Case presentation: A 75-year-old man had a 7.9-mm unruptured basilar tip aneurysm. A coil embolization was performed. An angiogram 6 months after the embolization showed complete occlusion of the aneurysm. We performed follow-up MRA approximately every 6 months. MRA one and a half years after the embolization showed residual at the neck of the aneurysm, which was gradually growing. MRA three and a half years after the operation showed dome filling of the aneurysm. Angiograms at that time showed that the dome filling reached at the tip of the aneurysm although the size of the aneurysm was unchanged. The patient refused retreatment. MRA 4 years after the operation showed growth of the aneurysm. The patient refused retreatment again. Six years after the treatment, the aneurysm was ruptured. Although we treated the aneurysm by coil embolization, the patient died 2 months after the treatment.
Conclusion: This case report illustrates valuable serial MRA images of complete occlusion, residual of the neck, dome filling, and rupture. Although many more cases should be examined, in this case, retreatment should be performed when dome filling reaches at the tip of an aneurysm or the aneurysm shows growth.
