Surgical clipping for a recurrent perforator aneurysm of the A1 segment following endovascular electrocoagulation...

Recently, endovascular electrocoagulation has been successfully used to treat ruptured aneurysms that cannot be catheterized with a microcatheter, but more research is needed to evaluate the efficacy of this technique. In this report, we present the first reported case of early aneurysm recurrence following electrocoagulation therapy and describe our experience of retreatment for this lesion.

A 51-year-old female presented with spontaneous subarachnoid hemorrhage, who was diagnosed with a rare tiny aneurysm arising from the A1 segment of anterior cerebral artery. Because of the sharp turning angle of parent artery and the extremely narrow aneurysm neck, attempts at catheterization of the aneurysm sac were unsuccessful. Thus, pure micro-guidewire electrocoagulation was selected as the salvage treatment approach. Initially, the aneurysm was successfully occluded by electrocoagulation, but follow-up angiography at 5 weeks postoperatively showed recanalization of the lesion. Eventually, the recurrent aneurysm was safely obliterated by surgical clipping, providing a direct view of the pathological changes following electrocoagulation therapy.

Endovascular electrocoagulation carries a risk of aneurysm recanalization despite initial success. Close angiographic follow-up is warranted to ensure the efficacy of this technique.