[Experience with electrothrombosis of a giant aneurysm with copper wire]

A 71-year-old woman with left internal carotid giant artery aneurysm was treated by copper wire electrothrombosis after craniotomy. In spite of almost obliteration of the giant aneurysm by copper wire insertion, the giant aneurysm bled and the patient died of severe subarachnoid hemorrhage. Autopsy showed massive subarachnoid clot, large intracerebral hematoma in the left frontal lobe and intraventricular hemorrhage with thrombosis in the giant aneurysm. From the autopsy findings and our experimental study, the mechanism of the aneurysmal rupture after copper wire insertion was speculated as follows. As the speed of the thrombosis formed by copper wire in the aneurysmal dome was disproportional to the blood flow, thrombosis was formed later in the most fragile part of the aneurysmal dome into which the blood flows more rapidly from the parent artery and this gives more hemodynamic stress to the aneurysmal wall. Then the aneurysm bleeds. From this result, it may be concluded that as the surgical treatment with elecrothrombosis for giant aneurysm is a very risky procedure, this procedure should be carefully chosen to obliterate the giant aneurysm.