Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome

Aneurysmal rupture during endovascular treatment is one of the most feared complications of endovascular aneurysm therapy. The purpose of this study was to determine the frequency, causes, management, and outcome of aneurysmal rupture that occurred during treatment with Guglielmi detachable coils (GDCs) in an unselected series of patients with ruptured cerebral aneurysms.

Between July 1997 and December 2000, we treated 164 acutely ruptured cerebral aneurysms with GDCs. All charts were reviewed, and patients with aneurysmal rupture occurring during embolization were identified.

Five patients had an intraprocedural aneurysmal rupture. In one patient, rupture was due to guidewire perforation of the wall. In two patients, the microcatheter itself perforated the aneurysm. In another two patients, rupture occurred during placement of the first coil. Endovascular packing was continued in all patients. One patient died as a result of the aneurysmal rupture. No negative long-term effects were observed in the remaining four patients. In summary, we observed intraprocedural aneurysmal rupture in 3% of our patients, with a mortality rate of 20% and no long-term morbidity.

Aneurysmal rupture during endovascular treatment with GDCs is a rare event; clinical severity may be variable. Embolization of the aneurysm can be continued in most cases, and most patients with treatment-related subarachnoid hemorrhage survive without serious sequelae.