Intraprocedural Rupture of Unruptured Cerebral Aneurysms During Coil Embolization: A Single-Center Experience

Incidence of intraprocedural rupture (IPR) during endovascular coiling is reported to be 2%-5%. We reviewed a single-center experience of IPR during coil embolization of unruptured intracranial aneurysms.

Between January 2011 and April 2016, 849 patients were treated with endovascular therapy for unruptured intracranial aneurysm. IPR was documented in 10 (1.18%) of these patients. We reviewed medical records to evaluate characteristics of the aneurysms, angiographic findings related to rupture, management, and outcomes.

Among the 10 patients, there were 4 internal carotid artery aneurysms, 3 anterior communicating artery aneurysms, 2 basilar tip aneurysms, and 1 middle cerebral artery aneurysm. The probable mechanism of IPR in 7 patients was focal coil mass distention. Two patients underwent rupture owing to injury by a microcatheter tip that was related to device-device interaction. In 1 patient who had no other clear etiology, increased intra-arterial pressure induced by contrast injection was suspected as a cause of rupture. In all cases, rapid occlusion at the point of suspected leakage was performed, and final angiography showed complete obliteration of the aneurysm. After the procedure, neurologic deterioration was demonstrated in 2 patients. The modified Rankin Scale score at 6-month follow-up was 0 in 7 of the patients.

Incidence of IPR during endovascular coiling of unruptured aneurysms is relatively low. Early detection followed by rapid occlusion of the aneurysm can lead to a benign clinical course in most cases.