Rerupture of cerebral aneurysms during angiography

To assess the incidence of angiography-related rerupture of intracranial aneurysms and to analyze other risk factors of this complication.

Clinical data from 144 patients with acute subarachnoid hemorrhage from ruptured intracranial aneurysm were reviewed retrospectively. In all patients, angiography was done by the transaortic approach.

The incidence of rerupture caused by angiography was 2 (1.4%) of 144 and that of spontaneous rerupture was 14 (9.7%) of 144. Angiography within 6 hours after the initial subarachnoid hemorrhage attack was associated with a significantly higher incidence of rerupture (4.8%) than that after a longer interval (0%). In cases of spontaneous rerupture, patients with worse levels of consciousness showed a higher incidence of rerupture, and this tendency also was evident in cases of induced rerupture. There was no significant correlation between the rerupture rate and the injection volume of contrast medium, aneurysm location, or patient age or sex.

Although angiography within 6 hours after initial intracranial aneurysm rupture was associated with a higher rate of rerupture, the incidence of rerupture in this study (4.8%) was much lower than those reported previously (20% to 38.5%). The present findings suggest that emergency angiography within 6 hours after aneurysm rupture, which enables neurosurgeons to carry out early surgery, should not be discouraged.