Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture

J Neurosurg. 2008 Jun;108(6):1088-92. doi: 10.3171/JNS/2008/108/6/1088.


Object: Procedure-related rupture during endovascular therapy of intracranial aneurysms is associated with a mortality rate of more than one third. Previously ruptured aneurysms are a known risk factor for procedure-related rupture. The objective of this study was to evaluate whether very small, ruptured aneurysms are associated with more frequent intraprocedural ruptures.

Methods: This was a retrospective cohort study in which the investigators examined consecutive ruptured aneurysms treated with coil embolization at a single institution. The study was approved by the institutional review board. Very small aneurysms were defined as < or = 3 mm. Procedure-related rupture was defined as contrast extravasation during treatment. Univariate analysis with the Fisher exact test and the Mann-Whitney U test was performed.

Results: Between August 1992 and January 2007, 682 aneurysms were selectively treated with coils in 668 patients. Procedure-related rupture occurred in 7 (11.7%) of 60 aneurysms < or = 3 mm, compared with 14 (2.3%) of 622 aneurysms > 3 mm (relative risk 5.2, 95% confidence interval 2.2-12.8; p < 0.001). Among cases with procedure-related rupture, inflation of a compliant balloon was associated with better outcome (Glasgow Outcome Scale Score > or = 4) compared with patients treated without balloon assistance (5 of 5 compared with 7 of 16; p = 0.05). Death resulting from procedure-related rupture occurred in 8 (38%) of 21 patients, and a vegetative state occurred in 1 patient. Clinical outcome was good in the other 12 patients (57%).

Conclusions: Endovascular coil embolization of very small (< or = 3 mm) ruptured cerebral aneurysms is 5 times more likely to result in procedure-related rupture compared with larger aneurysms. Balloon inflation for hemostasis may be associated with better outcome in the event of intraprocedural rupture and merits further study.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured / epidemiology*
  • Aneurysm, Ruptured / pathology
  • Aneurysm, Ruptured / therapy*
  • Angioplasty, Balloon / adverse effects*
  • Cohort Studies
  • Embolization, Therapeutic / adverse effects*
  • Female
  • Humans
  • Intracranial Aneurysm / epidemiology
  • Intracranial Aneurysm / pathology*
  • Intracranial Aneurysm / therapy*
  • Intraoperative Complications
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome