Intracranial aneurysm perforation during endosaccular coiling: impact on clinical outcome, initial occlusion, and...

The aim of this study was to evaluate the acute and follow-up outcomes of cerebral aneurysms that perforated during endovascular treatment.

Nine hundred ten patients harboring 1056 intracranial aneurysms received 1164 endovascular treatments over 11 years at our institution. Intraprocedural aneurysm perforation occurred in 20 cases (1.7%). Thirteen cases (mean size, 6.2 mm) demonstrated contrast leakage, whereas the other 7 cases (mean size, 5.3 mm) showed only nonleak coil extrusion from the aneurysms. Results of follow-up magnetic resonance angiography or catheter angiography at least 6 months after embolization were available in 11 contrast leak and 6 nonleak cases. Acute and follow-up results were reviewed.

New neurological deficits directly associated with aneurysm perforation were identified at discharge in only 4 contrast leak patients (20%). Their respective modified Rankin Scale scores were 1, 2, 3, and 5. Respective acute results in the contrast leak and nonleak groups were as follows: complete occlusion in 7 (54%) and 3 (43%), neck remnant in 3 (23%) and 4 (57%), and incomplete occlusion in 3 (23%) and 0. Respective follow-up results were as follows: major recanalization in 3 (27%) and 1 (17%), minor recanalization in 3 (27%) and 1 (17%), and stable occlusion in 5 (46%) and 4 (67%).

Intraprocedural aneurysm perforation with leakage of contrast appears to be associated with relatively high rates of incomplete acute results and major recanalizations during follow-up, although perforation frequently occurs in small aneurysms. Nonleak perforation may also lead to major recanalization through the potentially weak point of initial coil extrusion.