Prevention and management of intraprocedural rupture of intracranial aneurysm with detachable coils during embolization.

Authors:
Ming-Hua Li
Ming-Hua Li
The Sixth Affiliated People's Hospital
China
Chun Fang
Chun Fang
Shanghai Jiao Tong University
China
Ying-Sheng Cheng
Ying-Sheng Cheng
The Sixth Affiliated People's Hospital
China
Yong-Dong Li
Yong-Dong Li
Shanghai Jiao Tong University
China
Jue Wang
Jue Wang
Xi'an Jiaotong University
China
Guo-Ping Xu
Guo-Ping Xu
Fudan University
China

Neuroradiology 2006 Dec 27;48(12):907-15. Epub 2006 Sep 27.

Department of Radiology, Shanghai Sixth Hospital, Shanghai Jiaotong University School of Medicine, 600 Yishan Road, Shanghai 200233, People's Republic of China.

Introduction: Intracranial aneurysm rupture during embolization with detachable coils is reportedly among the gravest of intraprocedural complications. We present here our experiences with this outcome, and a potential intervention for managing this life-threatening complication.

Methods: From April 1998 to March 2005, 284 patients with cerebral aneurysms were treated with detachable coils. Intraprocedural aneurysm rupture occurred in ten patients with a history of a previously ruptured aneurysm. In the event of intraprocedural hemorrhage, we routinely performed heparin reversal with protamine sulfate.

Results: Of the 221 patients with a previously ruptured aneurysm, intraprocedural aneurysm rupture occurred in 10 (4.5%). These ruptures were caused by a micro-guide wire in one patient, a microcatheter in one, over-packing in two and a coil perforation in three. In the remaining three patients the ruptures were caused by both the microcatheter and the coils. Three patients died because of aneurysm re-rupture, yielding a mortality rate of 30%. One patient presented with a slight disability in the left leg and no neurological deficits were observed in the remaining six patients.

Conclusion: Intraprocedural aneurysm rupture during embolization is a rare, but unavoidable and life-threatening event. Proper measures should be taken to reduce and improve the outcome of this tragic occurrence. The majority of patients with an intraprocedural ruptured aneurysm can survive without severe sequelae if managed appropriately.

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December 2006
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