Report Coiling for Coiled Cerebral Aneurysm with Rapid Recurrence and Bleeding: Report of a Case

以重覆治療腦部動脈瘤栓塞後快速復發且再出血：病例報告

劉偉修(Wei-Hsiu Liu) ； 林恩源(En-Yuan Lin) ； 吳豪掦(Hao-Yiang Wu)

《Formosan Journal of Surgery》 40卷6期 (2007/12) Pp. 249-254

https://doi.org/10.29833/FJS.200712.0004

摘要

自發性蛛網膜下腔出血在急診室是一個常見的表現，通常是由於腦部動脈瘤破裂造成。傳統上，腦部動脈瘤是經由開顱手術在顯微鏡下以動脈夾治療：隨著經血管內治療科技的進步，近十年來全世界已有很多病患接受金屬線圈栓塞治療。雖然如此，此種治療的長期效果仍然在研究中：有些病患仍然的會遇到動脈瘤再生成或再疏通的問題。我們報告一位四十七歲男性罹患腦部前交通動脈瘤破裂，初次接受經血管內栓塞治療，但於不到兩個月的時間內快速形成一顆新的動脈瘤併破裂：再次接受經血管內手術將復發的動脈瘤安全栓塞。三個月後追蹤的血管攝影發現第二次栓塞的動脈瘤又再次疏通，故再次施行栓塞手術治療成功。特別值得一提的是第三次再栓塞後，病患呈現暫時性的顱內壓升高但無出血情況，給予爲期壹週的滲透壓利尿劑治療後恢復良好。我們回顧相關文獻並報告相關的臨床表徵、危險因子、致病機轉與再次以白金線圈栓塞治療的可行性。

並列摘要

Spontaneous subarachnoid hemorrhage (SAH) is a common presentation in an emergency department and most often results from a ruptured cerebral aneurysm. Traditionally, the aneurysm was managed with microsurgical clipping via open craniotomy. With advances in endovascular technology, many patients have been treated worldwide with coil embolization in the recent decade. Nevertheless, its longterm efficacy is still under investigation. Some patients will experience the problem of regrowth or recanalization of aneurysms. We report hereby a 47-year-old man with an anterior communicating artery (ACOM) aneurysm which was treated by endovascular coiling primarily. The aneurysm regrew rapidly later in another direction, however, and ruptured within 2 months. A second endovascular approach with coiling secured the recurrent aneurysm again smoothly. Upon further angiographic follow-up 3 months later, recanalization of the aneurysm after the second coiling occured. Repeat coiling was performed to embolize the aneurysm successfully. Remarkably, post-coiling headache developed after the third coiling procedure, but no evidence of rebleeding or rupture event was detected in a followup study. Conservative treatment with osmotic diuretic was given for one week and he recovered well. We have reviewed the relevant literature and present clinical features, risk factors, pathogenesis and the feasible management of repeat coiling.

並列關鍵字

endovascular coiling ； aneurysm ； subarachnoid hemorrhage ； recurrent