Intraprocedural cerebral aneurysm rupture during endovascular coiling

Neurol India. May-Jun 2011;59(3):369-72. doi: 10.4103/0028-3886.82736.

Abstract

Background: Intraprocedural aneurysm rupture is considered to be one of the most formidable complications of the endovascular treatment of cerebral aneurysms and is associated with high mortality.

Objective: To report the clinical outcomes of cerebral aneurysms that ruptured during endovascular coiling.

Patients and methods: Over a period of six years, 559 endovascular embolizations were performed in 467 patients, with 507 cerebral aneurysms. Intraprocedural aneurysm rupture occurred in 14 cases (mean aneurysm size, 3.8 mm). Follow-up angiograms, at a minimum of three months post embolization, were available in 11 living patients. Acute and follow-up results were reviewed.

Results: The difference in the rates of aneurysm perforation during endovascular coiling between ruptured and unruptured aneurysms was significant (P < 0.05). There were three (21.4%) deaths related to this complication and three (21.4%) patients developed new deficits (modified Rankin Scale scores 1 to 2). Acute results of embolization were: complete occlusion in eight (57.1%), neck remnant in two (14.3%), and incomplete occlusion in four (28.6%) patients. Long-term follow-up results in 11 living patients were: major recanalization in one (9.1%), minor recanalization in one (9.1%), and stable occlusion in nine (81.8%).

Conclusion: Intraprocedural aneurysm rupture frequently occurs in small aneurysms and appears to be associated with relatively high rates of mortality.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Ruptured / mortality
  • Aneurysm, Ruptured / pathology*
  • Aneurysm, Ruptured / surgery*
  • Cerebral Angiography
  • Embolization, Therapeutic
  • Female
  • Humans
  • Intracranial Aneurysm / mortality
  • Intracranial Aneurysm / pathology*
  • Intracranial Aneurysm / surgery*
  • Intraoperative Complications / mortality
  • Intraoperative Complications / pathology*
  • Intraoperative Complications / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents
  • Treatment Outcome