Outcomes after aneurysm rupture during endovascular coil embolization

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Intracranial aneurysm rupture during Guglielmi detachable coil (GDC) placement is a known but infrequently described complication.
• Management strategies and patient outcomes following this event require further elucidation.

Purpose of the Study:

• To describe the experience with intracranial aneurysm perforation during GDC placement.
• To report on neuroradiological and neurosurgical interventions and their impact on outcomes.

Main Methods:

• Retrospective review of 701 patients undergoing endovascular coiling for 734 intracranial aneurysms over a 6-year period.
• Identification and analysis of 10 cases of aneurysm perforation during the coiling procedure.
• Review of patient management, outcomes, and relevant literature.

Main Results:

• All 10 perforations occurred in previously ruptured aneurysms, with none in the initial 100 cases.
• Perforation occurred during microcatheterization (2 cases) or coil deposition (8 cases).
• Posterior circulation lesions had a worse prognosis (3 deaths) compared to anterior circulation (6 good/fair recoveries).
• Elevated intracranial pressure (ICP) was common, and emergency ventriculostomy improved outcomes in two patients.
• Factors like persistent hypertension and dye extravasation correlated with poor outcomes.

Conclusions:

• Previously ruptured aneurysms are more prone to perforation during endovascular treatment.
• Iatrogenic rupture of posterior circulation aneurysms carries a worse prognosis than anterior circulation lesions.
• Key management includes anticoagulation reversal, completion of embolization, and ICP management via ventriculostomy; neurosurgical availability is crucial.