J Korean Neurosurg Soc.  2016 Jan;59(1):6-10. 10.3340/jkns.2016.59.1.6.

Predictor and Prognosis of Procedural Rupture during Coil Embolization for Unruptured Intracranial Aneurysm

• Lee KM
• Jo KI
• Jeon P
• Kim KH
• Kim JS
• Hong SC

• KMID: 2152912
• DOI: http://doi.org/10.3340/jkns.2016.59.1.6

Abstract

OBJECTIVE
The objectives of this study was to determine the incidence and outcomes of procedural rupture (PR) during coil embolization of unruptured intracranial aneurysm (UIA) and to explore potential risk factors.
METHODS
This retrospective study evaluated 1038 patients treated with coil embolization between January 2001 and May 2013 in a single tertiary medical institute. PR was defined as evidence of rupture during coil embolization or post procedural imaging. The patient's medical records were reviewed including procedure description, image findings and clinical outcomes.
RESULTS
Twelve of 1038 (1.1%) patients showed PR. Points and time of rupture were parent artery rupture during stent delivery (n=2), aneurysm rupture during filling stage (n=9) and unknown (n=1). Two parent artery rupture and one aneurysm neck rupture showed poor clinical outcomes [modified Rankin Scale (mRs) >2] Nine aneurysm dome rupture cases showed favorable outcomes (mRS < or =2). Location (anterior cerebral artery) of aneurysm was associated with high procedural rupture rate (p<0.05).
CONCLUSION
The clinical course of a patientwith procedural aneurysm rupture during filling stage seemed benign. Parent artery and aneurysm neck rupture seemed relatively urgent, serious and life threatening. Although the permanent morbidity rate was low, clinicians should pay attention to prevent PR, especially when confronting the anterior cerebral artery aneurysm.

Keyword

Procedural rupture; Intracranial aneurysm; Endovascular; Unruptured

MeSH Terms

Aneurysm
Arteries
Embolization, Therapeutic*
Humans
Incidence
Intracranial Aneurysm*
Medical Records
Neck
Parents
Prognosis*
Retrospective Studies
Risk Factors
Rupture*
Stents

Figure

• 

  Fig. 1 Schematic images demonstrating type of rupture in this study. Types of rupture were categorized into two types–procedural parent artery rupture (A), procedural aneurysm (dome or neck) rupture (B) during coil embolization.

• 

  Fig. 2 Digital subtracted angiography showed contrast leakage (arrow) at distal anterior cerebral artery after stent deployment.

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