Open Access Case Report Journal of Vascular Medicine & Surgery J o u r n a l o f V a s c ul a r M e d i c i n e & S u r g e ry ISSN: 2329-6925 Backhaus et al., Vasc Med Surg 2017, 5:3 DOI: 10.4172/2329-6925.1000319 Volume 5 • Issue 3 • 1000319 J Vasc Med Surg, an open access journal ISSN: 2329-6925 *Corresponding author: Dr. Roland Backhaus, Department of Neurology, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany, Tel: 0941-941-0; E-mail: Roland.backhaus@gmail.com Received May 31, 2017; Accepted June 26, 2017; Published June 29, 2017 Citation: Backhaus R, Kremmler L, Kirzinger L, Wendl C, Schlachetzki F (2017) Neurovascular Compression Syndrome after Coiling Intracranial Aneurysm. J Vasc Med Surg 5: 319. doi: 10.4172/2329-6925.1000319 Copyright: © 2017 Backhaus R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Neurovascular Compression Syndrome after Coiling Intracranial Aneurysm Backhaus R 1 *, Kremmler L 1 , Kirzinger L 1 , Wendl C 2 and Schlachetzki F 1 1 Department of Neurology, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany 2 Department of Radiology, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany Abstract Objectives: Endovascular treatment of intracranial aneurysms using detachable coils is an established method by interventional radiologists. Next to prevention of subarachnoidal hemorrhage, prospective and retrospective studies have shown relief of symptoms caused by the mass effect of the aneurysm following this treatment. Patients and methods: We present cases of endovascular treated intracranial aneurysms in patients developing focal neurological symptoms due to a local perianeurysmal infammation. Furthermore, we review the literature to increase awareness of this complication, its pathophysiology and therapeutic options. Results: Only rare cases of local perianeurysmal infammation have been reported in literature. Clinical symptoms are heterogenous, up to focal seizures or symptoms of acute hydrozephalus. Pathophysiological, thrombembolism, local infammatory and mass are possible aetiological factors. However, overall long-term prognosis is good. Conclusion: Neurovascular compression syndrome after intracraniel aneurysm coiling is a rare and possibly delayed complication. With regard to various causes, diagnostic and therapeutic options should be considered. Keywords: Neurovascular; Intracranial aneurysma; Infammatory; Vertebrobasilar circulation Abbreviations: ADC: Apparent Difusion Coefcient; CSF: Cerebrospinal Fluid; CT: Computed Tomography; CTA: Computed Tomography Angiography; DSA: Digital Subtraction Angiography; DWI: Difusion-Weighted Imaging; FLAIR: Fluid Attenuated Inversion Recovery; FLASH: Fast Low Angle Shot; IV: Intravenous; MCA: Middle Cerebral Artery; MRA: Magnetic Resonance Angiography; MRI: Magnetic Resonance Imaging; PCA: Posterior Cerebral Artery; rtPA: Recombinant Tissue Plasminogen Activator; TCD: Transcranial Doppler Sonography; TOF: Time-of-Flight Introduction Endovascular treatment of aneurysms using detachable coils has evolved as a preferred alternative to classical surgical clipping to prevent rupture and subarachnoidal haemorrhage. For aneurysms located within the vertebrobasilar circulation, in particular, this treatment is frst choice. Coil-induced closure of the aneurysm sac fnally may reduce the lesion’s mass efect on surrounding tissue with a consequent reduction in neurological symptoms, if symptoms due to mass efect occurred. Most reported complications of endovascular coiling include coil displacement, aneurysm rupture or puncture, artery dissection, and cerebral embolism. Only anecdotal information exists on progression of aneurysm size, local infammation, and abscess formation afer endovascular treatment. First, we present the case of a 49-year-old woman in whom a complex set of complications arose afer aneurysm coiling and discuss current views on the subject and possible therapeutic options for rare side efects. In a second case we report about a 62-year-old man sufering from reduced consciousness, hemiparesis and dysarthria about three weeks afer successful coiling of two intracranial aneurysms. Patients and Methods Case 1: A 49-year-old woman was admitted to the hospital for mild right-sided hemiparesis due to an ischemic stroke in the subcortical white matter of the lef hemisphere, which was classifed as a lacunar stroke. During a diagnostic workup an asymptomatic aneurysm of the basilar artery was found (Figure 1). Diagnostic intra-arterial digital subtraction angiography (DSA), performed before interventional treatment, revealed that the aneurysm measured 9 × 6 mm and was accompanied by a small daughter aneurysm. Coils were placed in successful in both aneurysms. At the end of the procedure, a small coil loop could be seen to protrude from the larger compartment overlapping the small side aneurysm (Figure 1). Eight hours afer the intervention the patient developed bilateral mydriasis, which was followed by a progressive loss of consciousness. Emergency cerebral CT scanning with CTA ruled out the presence of aneurysm bleeding or ruptures but showed partial obliteration of the P 1 section of both posterior cerebral arteries (PCAs). IV treatment with the gpIIb/IIIa inhibitor (tirofban) was introduced. Immediate DSA confrmed the fndings of the CTA with intraluminal sparing of contrast media, which were suggestive of fresh thrombotic material in both PCAs (Figure 2). Afer local thrombolytic treatment with 4 mg rtPA, the patient recovered well. MRI revealed multiple small ischemic lesions with haemorrhagic transformation within the cerebellum and PCA territories; however, the patient showed no neurological defcits and was discharged from the hospital 5 days later. Te patient was sent home on a regimen of acetylsalicylic acid (100 mg/ day) and low-molecular-weight heparin (certoparin) for thrombosis prophylaxis. One week later the patient presented at the emergency room with progressive headaches and undulating double vision as well