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

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.