Intraprocedural re-rupture during endovascular treatment of ruptured intracranial aneurysms: A single-center...

Intraprocedural re-rupture (IPR-RR) of ruptured intracranial aneurysms is rare but often catastrophic. We aimed to quantify the incidence of IPR-RR at our institution and describe its clinical characteristics, procedural context, and outcomes.

Endovascular treatments for ruptured aneurysms at a tertiary center were reviewed. Intraprocedural re-rupture (IPR-RR) was defined as angiographic contrast extravasation or extrusion of a device tip beyond the aneurysm wall. The primary objective was to characterize the incidence of IPR-RR and identify associated clinical and procedural factors. Secondary endpoints included in-hospital mortality and discharge functional status as measured by the modified Rankin Scale (mRS 0-2 vs. > 2).

IPR-RR occurred in 17/702 cases (2.4%). Patients with IPR-RR were more frequently aged 18-40 years (35.3% vs. 12.2%, p = 0.011) and had aneurysms > 10 mm (18% vs. 4%). Vascular risk factors, including hypertension, diabetes, hyperlipidemia, and smoking history, were similarly distributed between groups. Balloon-assisted coiling was used in 82.4% vs. 58.0% (p = 0.114). Favorable discharge outcome occurred in 29.4% vs. 51.5% (p = 0.072), while in-hospital mortality was 17.6% vs. 10.2% (p = 0.580).

Intraprocedural re-rupture occurred in 2.4% of ruptured aneurysm treatments and was associated with worse early outcomes. Effective management relied on immediate coil packing, balloon inflation, and anticoagulation reversal. Procedural preparedness, including strict blood pressure control and readiness for cerebrospinal fluid diversion, is essential to limit secondary neurological injury in this rare but serious complication.