Delayed thromboembolic infarction associated with reconfiguration of Guglielmi detachable coils--case report

A 77-year-old woman presented with delayed thromboembolic infarction of a basilar artery trunk aneurysm that occurred 2 weeks after coil embolization of the unruptured aneurysm. The postoperative course was uneventful until the patient suffered sudden onset of consciousness disturbance 13 days after the treatment. Computed tomography showed no abnormality, but digital subtraction angiography revealed a thrombus extending from the aneurysm neck to a point distal to the basilar artery. Thrombolysis was achieved by the infusion of urokinase. Reconfiguration of the coil at the aneurysm neck was revealed compared with the initial configuration of the coil immediately after embolization. Magnetic resonance imaging obtained after the thrombolysis showed hyperintense areas in the bilateral occipital lobes and thalami. Periprocedural thromboembolic complications associated with coil embolization of an aneurysm are well known. However, delayed thromboembolic complications may occur in some patients after successful coil packing of an aneurysm.