Intraprocedure aneurysm rupture in embolization: clinical outcome with imaging correlation

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Neurology

Background:

• Intraprocedural aneurysm rupture (IPAR) is a significant complication during endovascular embolization of intracranial aneurysms.
• This study investigates the immediate and long-term imaging and clinical outcomes of IPAR.

Purpose of the Study:

• To analyze the incidence, causes, and imaging findings of IPAR during intracranial aneurysm embolization.
• To correlate imaging findings and hemodynamic compromise with clinical outcomes following IPAR.
• To evaluate the utility of brain CT in monitoring IPAR progression and tissue loss.

Main Methods:

• Retrospective analysis of 376 patients with 412 intracranial aneurysms treated with coil embolization over 9 years.
• Identification of 10 patients (2.7%) who experienced IPAR.
• Review of immediate cerebral angiography and brain CT, plus follow-up CT; clinical outcomes assessed using the modified Rankin scale (mRS).

Main Results:

• IPAR causes included coil protrusion (70%), microcatheter perforation (20%), and spontaneous rupture (10%).
• Angiographic cerebral hemodynamic compromise occurred in 40% of patients, correlating with poor outcomes.
• Immediate CT showed contrast media/hemorrhage expansion; 60% of patients had cerebral tissue loss on follow-up CT.
• Long-term outcomes: 60% good recovery (mRS ≤ 2), 10% moderate disability (mRS 4), 30% mortality (mRS 6).

Conclusions:

• IPAR is an infrequent complication, often occurring during coil deployment.
• Angiographic hemodynamics is a critical predictor of IPAR outcomes.
• Brain CT effectively visualizes IPAR progression and associated ischemic or hemorrhagic tissue damage.