Intra-aneurysmal pressure changes during angiography in coil embolization

Surg Neurol. 1997 Nov;48(5):451-7. doi: 10.1016/s0090-3019(97)00278-4.


Background: Although elevation of blood pressure in aneurysms induced by injection of contrast medium has been postulated as a major cause of rerupture of ruptured cerebral aneurysms during angiography, no study has proved the elevation of intra-aneurysmal pressure because of difficulty in measuring the intra-aneurysmal pressure during angiography. The present study demonstrated intra-aneurysmal pressure to be raised by injection of contrast medium, using a microcatheter introduced into aneurysms.

Methods: To confirm the accuracy of pressure measurement through a microcatheter, we measured intra-aneurysmal pressure in a plastic model of an artery and an aneurysm during and after injection of contrast medium through a microcatheter and a needle inserted into the aneurysm. In a clinical study, intra-aneurysmal pressures were measured through the microcatheter in nine cerebral aneurysms of seven patients.

Results: In the model experiment, changes in the pressure measured through the microcatheter correlated well with those observed through the needle. In the clinical study, intra-aneurysmal systolic pressures increased by 5-23 mm Hg immediately after injection of contrast medium for 1-3 s in four basilar tip, three internal carotid-ophthalmic, and one middle cerebral artery aneurysm, whereas no pressure change was observed in a posterior cerebral artery aneurysm. Systemic blood pressure during angiography remained unchanged in all cases.

Conclusions: This abruptly elevated intra-aneurysmal pressure by injection of contrast medium might cause rerupture of an aneurysm soon after rupture of the aneurysm, especially when the rupture site is fragile.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Ruptured / etiology*
  • Aneurysm, Ruptured / physiopathology
  • Blood Pressure*
  • Cerebral Angiography / adverse effects*
  • Cerebral Angiography / methods
  • Contrast Media / adverse effects
  • Embolization, Therapeutic* / methods
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / physiopathology*
  • Intracranial Aneurysm / therapy
  • Male
  • Middle Aged
  • Models, Cardiovascular
  • Recurrence


  • Contrast Media