Abstract
This chapter describes the clinical and radiological findings of a 43-year-old woman with a subacute SAH and a clot in the fourth ventricle with a subsequent dilatation of the lateral ventricles. During the diagnostic angiography under local anesthesia, an acute rupture of an aneurysm on the right-hand posterior communicating artery (PcomA) occurred. This aneurysm was subsequently treated by balloon-assisted coil embolization. Despite the recurrent rupture with subarachnoid hemorrhage (SAH), a good clinical outcome was achieved. The complete occlusion of the aneurysm was confirmed by a follow-up DSA after 3 months. This case illustrates the risk of an aneurysm re-rupture during a diagnostic angiography. In patients with a previous aneurysm rupture, it is advisable to perform DSA under general anesthesia, even if the patient is in good clinical condition. Rotational DSA with machine injection of contrast medium should be avoided in the acute phase after an SAH. If an aneurysm re-ruptures during DSA, an immediate coil occlusion of said aneurysm is imperative. The conditions, which might contribute to the re-rupture of an aneurysm during DSA and the management of this complication, are the main topics of this chapter.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Deecke L, Goldscheider HG, Rittmeyer K. Aneurysmal rupture during angiography. Arch Psychiatr Nervenkr (1970). 1978;226(1):37–42.
Jamieson KG. Rupture of an intracranial aneurysm during cerebral angiography. J Neurosurg. 1954;11(6):625–8.
Kaufmann TJ, Huston J 3rd, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF. Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology. 2007;243(3):812–9.
Klisch J, Weyerbrock A, Spetzger U, Schumacher M. Active bleeding from ruptured cerebral aneurysms during diagnostic angiography: emergency treatment. AJNR Am J Neuroradiol. 2003;24(10):2062–5.
Komiyama M, Tamura K, Nagata Y, Fu Y, Yagura H, Yasui T. Aneurysmal rupture during angiography. Neurosurgery. 1993;33(5):798–803.
Mironov A, Marquardt B, Thron A. Rupture of intracranial aneurysms during angiography and CT: coincidental or causal event? A case report. Neurochirurgia (Stuttg). 1984;27(5):146–9.
Saitoh H, Hayakawa K, Nishimura K, Okuno Y, Murayama C, Miyazawa T, Zieroth BF, Shimizu Y. Intracarotid blood pressure changes during contrast medium injection. AJNR Am J Neuroradiol. 1996;17(1):51–4.
Stoeter P, Prey N, Hoffmann C, Büdingen HJ, Bergleiter R. Doppler-sonographic examination of the arterial flow in the carotid and supratrochlear arteries during carotid angiography. Neuroradiology. 1984;26(3):199–207.
Waga S, Kondo A, Moritake K, Handa H. Rupture of intracranial aneurysm during angiography. Neuroradiology. 1973;5(3):169–73.
Xu D, Wang C, Zhang C, Xiang S, Xie X. Rupture of vertebral artery dissection aneurysm during 3D DSA. Neurology. 2016;87(2):236. https://doi.org/10.1212/WNL.0000000000002846.
Zaehringer M, Wedekind C, Gossmann A, Krueger K, Trenschel G, Landwehr P. Aneurysmal re-rupture during selective cerebral angiography. Eur Radiol. 2002;12(Suppl 3):S18–24.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Loehr, C., Kuhnt, J.O., AlMatter, M., Henkes, H. (2020). Posterior Communicating Artery Aneurysm: Unrecognized Previous Rupture, Recurrent Rupture During Angiography, Emergent Balloon-Assisted Coil Occlusion, Good Clinical Outcome. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-77827-3_36
Download citation
DOI: https://doi.org/10.1007/978-3-319-77827-3_36
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-77826-6
Online ISBN: 978-3-319-77827-3
eBook Packages: MedicineReference Module Medicine