Spontaneous Thrombosis of Significant Aneurysm Recanalization in the Long Term Follow-up of Coiled Aneurysms: Observation in Two Cases

Abstract

Endovascular treatment of cerebral aneurysms with detachable coils has now been proved to be a superior alternative to open microsurgery in terms of survival free of disability at one year according to the recently published large randomized International Subaracnoid Aneurysm Trial (ISAT). However, aneurysm recanalization secondary to coil compaction is still the main problem of this technique observed in the follow-up period but treatment strategies for these regrowths are not yet well established. We present two interesting cases in which we observed a significant aneurysm recanalization at six month control angiography that was found to be spontaneously thrombosed in the late follow-up angiograms at the second and fifth years consecutively.

Figure 1

A) Conventional angiography on anterior-posterior (A-P) projection shows a saccular aneurysm in the A1 portion of the right anterior cerebral artery. B) Postembolization control angiography on oblique projection demonstrates completely embolized aneurysmal sac. C) Six months follow-up angiography on A-P projection shows recanalization at the neck of the previously embolized aneurysm. D) Second year control examination with right internal carotid artery injection on A-P projection reveals spontaneous thrombosis of the recanalization. E) Fifth year angiography demonstrates stable occlusion of the sac.

Figure 1

A) Conventional angiography on anterior-posterior (A-P) projection shows a saccular aneurysm in the A1 portion of the right anterior cerebral artery. B) Postembolization control angiography on oblique projection demonstrates completely embolized aneurysmal sac. C) Six months follow-up angiography on A-P projection shows recanalization at the neck of the previously embolized aneurysm. D) Second year control examination with right internal carotid artery injection on A-P projection reveals spontaneous thrombosis of the recanalization. E) Fifth year angiography demonstrates stable occlusion of the sac.

Figure 2

A) Angiography at A-P projection reveals three aneurysms of which the largest is seen at the anterior communicating artery. The other two aneurysms are seen at the right middle cerebral artery bifurcation and the supraclinoid portion of the internal carotid artery. B) Control angiography after embolization and surgery on A-P projection demonstrates total occlusion of the embolized anterior communicating aneurysm. The other two aneurysms, which were surgically clipped, are also eliminated from the circulation. C) Angiography performed at 6^th month follow-up on oblique projection shows the significant recanalization of the previously coiled aneurysm. D) Fifth year follow-up reveals spontaneous thrombosis of the recanalized aneurysm.