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

View More View Less
  • 1 Department of Neurology, Neurosurgery, and Radiology, Boston University Medical Center, Boston, Massachusetts;
  • 2 Department of Radiology and
  • 3 Division of Neurology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada; and
  • 4 Department of Radiology, Ains Shams University, Cairo, Egypt
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

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 ≤ 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 ≤ 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 ≥ 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 (≤ 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.

Abbreviations used in this paper: GOS = Glasgow Outcome Scale; ICP = intracranial pressure; MCA = middle cerebral artery; PICA = posterior inferior cerebellar artery; SCA = superior cerebellar artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Alain Weill, M.D., Department of Radiology, Notre Dame Hospital, 1560 Sherbrooke Street East, Montreal, Quebec H2L 4M1, Canada. email: alain.weill.chum@ssss.gouv.qc.ca.
  • 1

    Batjer H, & Samson D: Intraoperative aneurysmal rupture: incidence, outcome, and suggestions for surgical management. Neurosurgery 18:701707, 1986

    • Search Google Scholar
    • Export Citation
  • 2

    Cloft HJ, & Kallmes DF: Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. AJNR Am J Neuroradiol 23:17061709, 2002

    • Search Google Scholar
    • Export Citation
  • 3

    Cognard C, , Weill A, , Castaings L, , Rey A, & Moret J: Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:499510, 1998

    • Search Google Scholar
    • Export Citation
  • 4

    Doerfler A, , Wanke I, , Egelhof T, , Dietrich U, , Asgari S, & Stolke D, : Aneurysmal rupture during embolization with Guglielmi Detachable Coils: causes, management, and outcome. AJNR Am J Neuroradiol 22:18251832, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    Fridriksson S, , Saveland H, , Jakobsson KE, , Edner G, , Zygmunt S, & Brandt L, : Intraoperative complications in aneurysm surgery: a prospective national study. J Neurosurg 96:515522, 2002

    • Search Google Scholar
    • Export Citation
  • 6

    Houkin K, , Kuroda S, , Takahashi A, , Takikawa S, , Ishikawa T, & Yoshimoto T, : Intra-operative premature rupture of the cerebral aneurysms. Analysis of the causes and management. Acta Neurochir (Wien) 141:12551263, 1999

    • Search Google Scholar
    • Export Citation
  • 7

    Johnston SC, & Elijovich L: Predictors and outcome of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke 38:P489, 2007. (Abstract)

    • Search Google Scholar
    • Export Citation
  • 8

    McDougall CG, , Halbach VV, , Dowd CF, , Higashida RT, , Larsen DW, & Hieshima GB: Causes and management of aneurysmal hemorrhage occurring during embolization with Guglielmi detachable coils. J Neurosurg 89:8792, 1998

    • Search Google Scholar
    • Export Citation
  • 9

    Molyneux A, , Kerr R, , Stratton I, , Sandercock P, , Clarke M, & Shrimpton J, : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 26:12671274, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Moret J, , Cognard C, , Weill A, , Castaings L, & Rey A: Reconstruction technique in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results Apropos of 56 cases. J Neuroradiol 24:3044, 1997

    • Search Google Scholar
    • Export Citation
  • 11

    Piotin M, , Mounayer C, , Spelle L, , Williams MT, & Moret J: Endovascular treatment of anterior choroidal artery aneurysms. AJNR Am J Neuroradiol 25:314318, 2004

    • Search Google Scholar
    • Export Citation
  • 12

    Raymond J, & Roy D: Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41:12351246, 1997

  • 13

    Ricolfi F, , Le Guerinel C, , Blustajn J, , Combes C, , Brugieres P, & Melon E, : Rupture during treatment of recently ruptured aneurysms with Guglielmi Electrodetachable Coils. AJNR Am J Neuroradiol 19:16531658, 1998

    • Search Google Scholar
    • Export Citation
  • 14

    Sluzewski M, , Bosch JA, , van Rooij WJ, , Nijssen PCG, & Wijnalda D: Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors. J Neurosurg 94:238240, 2001

    • Search Google Scholar
    • Export Citation
  • 15

    Suzuki S, , Kurata A, , Ohmomo T, , Sagiuchi T, , Niki J, & Yamada M, : Endovascular surgery for very small ruptured aneurysms. Technical note. J Neurosurg 105:777780, 2006

    • Search Google Scholar
    • Export Citation
  • 16

    Van Rooij WJ, , Sluzewski M, , Beute GN, & Nijssen PC: Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 27:14981501, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Vanninen R, , Koivisto T, , Saari T, , Hernesniemi J, & Vapalahti M: Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils – a prospective randomized study. Radiology 211:325336, 1999

    • Search Google Scholar
    • Export Citation
  • 18

    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

    • Search Google Scholar
    • Export Citation
  • 19

    Willinsky R, & terBrugge K: Use of a second microcatheter in the management of a perforation during endovascular treatment of a cerebral aneurysm. AJNR Am J Neuroradiol 21:15371539, 2000

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 991 739 13
Full Text Views 196 32 0
PDF Downloads 146 15 0
EPUB Downloads 0 0 0