Intraprocedure aneurysm rupture in embolization: Clinical outcome with imaging correlation

BackgroundIntraprocedural aneurysm rupture (IPAR) is the most feared complication of embolization for intracranial aneurysms. Here we report the immediate and long-term imaging outcomes of IPAR during embolization and the correlation with clinical outcomes.MethodsOf the 376 consecutive patients harboring 412 intracranial aneurysms who had underwent endovascular coil embolizations in the past 9 years, 10 patients (2.7% per patient, 2.4% per aneurysm) had IPAR. There were two men and eight women, with an age range of 40–71 years (mean: 52 years). Imaging findings, including immediate cerebral angiography, brain computed tomography (CT), and follow-up CT, were analyzed. Final clinical patient outcome was evaluated by modified Rankin scale (mRS).ResultsThe causes of the IPARs were coil protrusion (n = 7), microcatheter perforation (n = 2), or they were spontaneous (n = 1). Nine cases involved previously ruptured aneurysms, while one was unruptured; aneurysmal location of the IPARs was the anterior (n = 5) or posterior (n = 4) communicating artery or the anterior cerebral artery (n = 1). Angiographic cerebral hemodynamic compromise was observed in four patients and associated with poor clinical outcomes. Immediate CT showed contrast media and/or intracranial hemorrhage expansion in all the patients. Cerebral tissue loss due to ischemia and/or hemorrhagic occurred in six patients with more than 3 months of follow-up. On more than a 3-month clinical outcome, six patients presented with good recoveries (mRS: ≤ 2). One patient exhibited a moderate disability (mRS: 4), and three patients died (mRS: 6).ConclusionIPAR is an uncommon complication and usually occurs during the advancement of the coil into the aneurysm sac. Angiographic hemodynamics is an important indicator to determine the outcome of the IPAR. Brain CT demonstrates the progression of the IPAR and the cerebral tissue loss resulting from ischemic or hemorrhagic events.