Causes and management of aneurysmal hemorrhage occurring during embolization with Guglielmi detachable coils

Cameron G. McDougall Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Van V. Halbach Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Christopher F. Dowd Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Randall T. Higashida Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Donald W. Larsen Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Grant B. Hieshima Department of Radiology, University of California at San Francisco Medical Center, San Francisco, California

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Object. The purpose of this review is to describe the incidence, causes, management, and outcome of aneurysmal hemorrhage that occurred in patients during endovascular treatment with the Guglielmi detachable coil (GDC) system.

Methods. At the authors' institution between September 1991 and August 1995, more than 200 patients were treated using GDCs for intracranial aneurysms. The first 200 patients treated in this fashion were reviewed and all who experienced new subarachnoid hemorrhage (SAH) during the procedure were identified. Angiographic studies were also reviewed and patients were contacted for longer-term follow up when possible.

Four patients who experienced intraprocedural SAH were identified. The causes of hemorrhage were believed to be perforation of the aneurysm by the guidewire in one patient, perforation by the microcatheter in a second, and perforation by the delivery wire in a third. The fourth patient had a hemorrhage during injection of contrast material for control angiographic studies after placement of the final coil. One patient died, but the other three experienced no neurological symptoms or recovered without acquiring additional deficits. Overall a procedural hemorrhage rate of 2% was seen, with permanent morbidity and mortality rates of 0% and 0.5%, respectively.

Conclusions. Although SAH during endovascular treatment of intracranial aneurysms remains a significant risk, its incidence is low and a majority of patients can survive without serious sequelae.

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  • 1.

    Beamer YB, , Corsino JF, & Lynde RG: Rupture of an aneurysm of the internal carotid artery during arteriography with filling of the subarachnoid space and demonstration of a temporal lobe mass. Case report. J Neurosurg 31:224226, 1969 Beamer YB, Corsino JF, Lynde RG: Rupture of an aneurysm of the internal carotid artery during arteriography with filling of the subarachnoid space and demonstration of a temporal lobe mass. Case report. J Neurosurg 31:224–226, 1969

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Dublin AB, & French BN: Cerebral aneurysmal rupture during angiography with confirmation by computed tomography: a review of intra-angiographic aneurysmal rupture. Surg Neurol 13:1927, 1980 Dublin AB, French BN: Cerebral aneurysmal rupture during angiography with confirmation by computed tomography: a review of intra-angiographic aneurysmal rupture. Surg Neurol 13:19–27, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Fernandez Zubillaga A, , Guglielmi G, & Viñuela F, et al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815820, 1994 Fernandez Zubillaga A, Guglielmi G, Viñuela F, et al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815–820, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Ferrari G, & Vio M: Radiological demonstration of rupture of a carotid aneurysm during cerebral angiography. Case report. J Neurosurg 31:462464, 1969 Ferrari G, Vio M: Radiological demonstration of rupture of a carotid aneurysm during cerebral angiography. Case report. J Neurosurg 31:462–464, 1969

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Fraser KW, , Halbach VV, & Teitelbaum GP, et al: Endovascular platinum coil embolization of incompletely surgically clipped cerebral aneurysms. Surg Neurol 41:48, 1994 Fraser KW, Halbach VV, Teitelbaum GP, et al: Endovascular platinum coil embolization of incompletely surgically clipped cerebral aneurysms. Surg Neurol 41:4–8, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Gobin YP, , Viñuela F, & Gurian JH, et al: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:5562, 1996 Gobin YP, Viñuela F, Gurian JH, et al: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:55–62, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Goldstein SL: Ventricular opacification secondary to rupture of an intracranial aneurysm during angiography. Case report. J Neurosurg 27:265267, 1967 Goldstein SL: Ventricular opacification secondary to rupture of an intracranial aneurysm during angiography. Case report. J Neurosurg 27:265–267, 1967

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Graves VB, , Strother CM, & Duff TA, et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:640648, 1995 Graves VB, Strother CM, Duff TA, et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:640–648, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Guglielmi G, & Viñuela F: Intracranial aneurysms. Guglielmi electrothrombotic coils. Neurosurg Clin North Am 5:427435, 1994 Guglielmi G, Viñuela F: Intracranial aneurysms. Guglielmi electrothrombotic coils. Neurosurg Clin North Am 5:427–435, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Guglielmi G, , Viñuela F, & Dion J, et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:814, 1991 Guglielmi G, Viñuela F, Dion J, et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:8–14, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Guglielmi G, , Viñuela F, & Duckwiler G: Coil-induced thrombosis of intracranial aneurysms, in Maciunas RJ (ed): Endovascular Neurological Intervention. Park Ridge, IL: American Association of Neurological Surgeons, 1995, pp 179187 Guglielmi G, Viñuela F, Duckwiler G: Coil-induced thrombosis of intracranial aneurysms, in Maciunas RJ (ed): Endovascular Neurological Intervention. Park Ridge, IL: American Association of Neurological Surgeons, 1995, pp 179–187

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Guglielmi G, , Viñuela F, & Duckwiler G, et al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515524, 1992 Guglielmi G, Viñuela F, Duckwiler G, et al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515–524, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Guglielmi G, , Viñuela F, & Sepetka I, et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:17, 1991 Guglielmi G, Viñuela F, Sepetka I, et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:1–7, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Halbach VV, , Higashida RT, & Dowd CF, et al: Management of vascular perforations that occur during neurointerventional procedures. AJNR 12:319327, 1991 Halbach VV, Higashida RT, Dowd CF, et al: Management of vascular perforations that occur during neurointerventional procedures. AJNR 12:319–327, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Jackson JR, , Tindall GT, & Nashold BS Jr: Rupture of an intracranial aneurysm during carotid arteriography. A case report. J Neurosurg 17:333336, 1960 Jackson JR, Tindall GT, Nashold BS Jr: Rupture of an intracranial aneurysm during carotid arteriography. A case report. J Neurosurg 17:333–336, 1960

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Jamieson KG: Rupture of an intracranial aneurysm during cerebral angiography. J Neurosurg 11:625628, 1954 Jamieson KG: Rupture of an intracranial aneurysm during cerebral angiography. J Neurosurg 11:625–628, 1954

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Kassell NF, , Torner JC, & Haley Jr EC, et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:1836, 1990 Kassell NF, Torner JC, Haley Jr EC, et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:18–36, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Komiyama M, , Tamura K, & Nagata Y, et al: Aneurysmal rupture during angiography. Neurosurgery 33:798803, 1993 Komiyama M, Tamura K, Nagata Y, et al: Aneurysmal rupture during angiography. Neurosurgery 33:798–803, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Lin JPT, , Kricheff II, & Chase NE: Blood pressure changes during retrograde brachial angiography. Radiology 83:640646, 1964 Lin JPT, Kricheff II, Chase NE: Blood pressure changes during retrograde brachial angiography. Radiology 83:640–646, 1964

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Locksley HB: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, Part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 25:321368, 1966 Locksley HB: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, Part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 25:321–368, 1966

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    McDougall CG, , Halbach VV, & Dowd CF, et al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:393399, 1996 McDougall CG, Halbach VV, Dowd CF, et al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:393–399, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Nishioka H, , Torner JC, & Graf CJ, et al: Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage: a long-term prognostic study. II. Ruptured intracranial aneurysms managed conservatively. Arch Neurol 41:11421146, 1984 Nishioka H, Torner JC, Graf CJ, et al: Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage: a long-term prognostic study. II. Ruptured intracranial aneurysms managed conservatively. Arch Neurol 41:1142–1146, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Osgood C, & Martin LG: Intraventricular contrast extravasation during carotid angiography. Surg Neurol 2:4950, 1974 Osgood C, Martin LG: Intraventricular contrast extravasation during carotid angiography. Surg Neurol 2:49–50, 1974

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Perret G, & Nishioka H: Report of the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section IV. Cerebral angiography. An analysis of the diagnostic value and complications of carotid and vertebral angiography in 5484 patients. J Neurosurg 25:98113, 1966 Perret G, Nishioka H: Report of the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section IV. Cerebral angiography. An analysis of the diagnostic value and complications of carotid and vertebral angiography in 5484 patients. J Neurosurg 25:98–113, 1966

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Richling B, , Bavinzske G, & Gross C, et al: Early clinical outcome of patients with ruptured cerebral aneurysms treated by endovascular (GDC) or microsurgical techniques. Intervent Neuroradiol 1:1927, 1995 Richling B, Bavinzske G, Gross C, et al: Early clinical outcome of patients with ruptured cerebral aneurysms treated by endovascular (GDC) or microsurgical techniques. Intervent Neuroradiol 1:19–27, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Saitoh H, , Hayakawa K, & Nishimura K, et al: Intracarotid blood pressure changes during contrast medium injection. AJNR 17:5154, 1996 Saitoh H, Hayakawa K, Nishimura K, et al: Intracarotid blood pressure changes during contrast medium injection. AJNR 17:51–54, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Saitoh H, , Hayakawa K, & Nishimura K, et al: Rerupture of cerebral aneurysm during angiography. AJNR 16:539542, 1995 Saitoh H, Hayakawa K, Nishimura K, et al: Rerupture of cerebral aneurysm during angiography. AJNR 16:539–542, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Tsementzis SA, , Kennett RP, & Hitchcock ER: Rupture of intracranial vascular lesions during arteriography. J Neurol Neurosurg Psychiatry 47:795798, 1984 Tsementzis SA, Kennett RP, Hitchcock ER: Rupture of intracranial vascular lesions during arteriography. J Neurol Neurosurg Psychiatry 47:795–798, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Viñuela F, , Duckwiler G, & Mawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475482, 1997 Viñuela F, Duckwiler G, Mawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Yasui T, , Kishi H, & Komiyama M, et al: Very poor prognosis in cases with extravasation of the contrast medium during angiography. Surg Neurol 45:560565, 1996 Yasui T, Kishi H, Komiyama M, et al: Very poor prognosis in cases with extravasation of the contrast medium during angiography. Surg Neurol 45:560–565, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation

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