Coil embolization of an acutely ruptured saccular aneurysm.

Acutely ruptured intracerebral berry aneurysms are usually treated by surgical clipping. In some instances, however, an endovascular approach to aneurysm obliteration may be considered. Since the pioneering work of Serbinenko [1] and Shcheglov (paper presented at the annual meeting of the ASNR, March 1989), there has been encouraging progress in the endovascular treatment of intracranial berry aneurysms by detachable balloon occlusion. Indications include aneurysms that cannot be surgically clipped, those with high surgical risk, those in inaccessible sites (e.g. , cavernous carotid artery), and patients who are poor surgical candidates because of underlying medical conditions [2]. Detachable balloon occlusion is suitable for selected aneurysms but may be ineffective in the acute stages of rupture. There have been few reports of endovascular treatment of acutely ruptured aneurysms and none in which the aneurysm was actively leaking. We have successfully treated a patient with an acutely ruptured berry aneurysm by placing platinum microcoils within the aneurysm after balloon occlusion failed. Longterm follow-up angiography has shown continued complete obliteration of the aneurysm. These preliminary results suggest that platinum microcoil occlusion may be an appropriate therapy for certain acutely ruptured intracranial berry aneurysms.