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A Case of Brainstem Hemorrhage Following Embolization of a Large Basilar Aneurysm with Hydrogel-Coated Coils Makoto FURUICHI 1 , Kentaro SHIMODA 1 , Toshikazu KANO 1 , Shoshi SATOH 1 , Atsuo YOSHINO 2 1Department of Neurosurgery, Kawaguchi Municipal Medical Center 2Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine Keyword: basilar aneurysm , coil embolization , hydrogel-coated coils , brainstem hemorrhage pp.835-842
Published Date 2015/9/10
DOI https://doi.org/10.11477/mf.1436203130
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 Objective:Endovascular coil embolization of intracranial aneurysms is associated with better outcomes and a lower mortality rate compared with surgical clip occlusion. However, a principal disadvantage of endovascular therapy is the higher rate of retreatment compared with neurosurgical clipping. Self-expandable hydrogel-coated coils were developed to reduce recanalization rates of cerebral aneurysms by promoting complete volumetric aneurysm occlusion. Herein, we report a case of brainstem hemorrhage following coil embolization of a large basilar aneurysm with hydrogel-coated coils.

 Case presentation:A 65-year-old female with a history of hypertension, who presented with worsening headaches, right hemiplegia, and left oculomotor palsy, underwent endovascular treatment for a large basilar aneurysm. The aneurysm was treated with both hydrogel-coated coils and bare platinum coils. Hydrogel-coated coils represented 46% of the coil length in the aneurysm. The patient was discharged from the hospital with improvement of neurological deficits 6 days after the procedure. However, the patient was readmitted with perianeurysmal edema in the midbrain 23 days after coil embolization. Follow-up angiography 26 days after the procedure showed complete obliteration of the aneurysm. Two weeks later, the patient presented with a large brainstem hemorrhage and died. Pathological findings revealed intraparenchymal hemorrhage in the pons without rupture of the aneurysm.

 Conclusion:Hydrogel-coated coils may cause a marked inflammatory response that may result in intracerebral hemorrhage.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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