Intraprocedural cerebral aneurysm rupture during endovascular coiling

BACKGROUND: Intraprocedural aneurysm rupture is considered to be one of the most formidable complications of the endovascular treatment of cerebral aneurysms and is associated with high mortality. OBJECTIVE: To report the clinical outcomes of cerebral aneurysms that ruptured during endovascular coiling. PATIENTS AND METHODS: Over a period of six years, 559 endovascular embolizations were performed in 467 patients, with 507 cerebral aneurysms. Intraprocedural aneurysm rupture occurred in 14 cases (mean aneurysm size, 3.8 mm). Follow-up angiograms, at a minimum of three months post embolization, were available in 11 living patients. Acute and follow-up results were reviewed. RESULTS: The difference in the rates of aneurysm perforation during endovascular coiling between ruptured and unruptured aneurysms was significant (P < 0.05). There were three (21.4%) deaths related to this complication and three (21.4%) patients developed new deficits (modified Rankin Scale scores 1 to 2). Acute results of embolization were: complete occlusion in eight (57.1%), neck remnant in two (14.3%), and incomplete occlusion in four (28.6%) patients. Long-term follow-up results in 11 living patients were: major recanalization in one (9.1%), minor recanalization in one (9.1%), and stable occlusion in nine (81.8%). CONCLUSION: Intraprocedural aneurysm rupture frequently occurs in small aneurysms and appears to be associated with relatively high rates of mortality.