Posterior Communicating Artery Aneurysm: Unrecognized Previous Rupture, Recurrent Rupture during Angiography, Emergent Balloon-Assisted Coil Occlusion, Good Clinical Outcome

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 three 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.