Intraprocedural Rupture During Endovascular Treatment of Intracranial Aneurysm: Clinical Results and Literature Review

• Published in: World neurosurgery 2018-06, Vol.114, p.e605-e615
• Main Authors: Park, Yung Ki, Yi, Hyeong-Joong, Choi, Kyu-Sun, Lee, Young-Jun, Chun, Hyoung-Joon
• Format: Article
• Language: English
• Subjects: Endovascular procedures; Intracranial aneurysm; Intraoperative complications; Subarachnoid hemorrhage
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.03.040

Intraprocedural rupture (IPR) during endovascular treatment of cerebral aneurysm is the most feared complication, with high morbidity and mortality. The aim of this study was to estimate the incidence and risk factors of IPR during endovascular treatment of ruptured and unruptured cerebral aneurysms. A total of 235 intracranial aneurysms (80 ruptured and 155 unruptured) in 219 patients who received endovascular treatment in our institution between January 2010 and December 2016 were enrolled in our study. Demographic and radiologic data were analyzed to evaluate risk factors of IPR. We conducted a literature review to estimate the incidence of IPR according to rupture status and aneurysm location. Ten patients (6 ruptured, 4 unruptured) experienced IPR during endovascular treatment. The IPR incidence was 7.5% in ruptured and 2.5% in unruptured aneurysms. Aneurysm size (smaller than 3.58 mm) and anterior communicating artery aneurysm were independent risk factors for IPR. According to the literature review, the overall IPR incidence was 4.47% (393/8791) in ruptured and 1.43% (145/10,131) in unruptured aneurysms. Independent risk factors for IPR during endovascular treatment of intracranial aneurysm were aneurysm size and anterior communicating artery aneurysm. Ruptured aneurysms showed a higher tendency toward IPR than did unruptured aneurysms. •Small aneurysm size and ACoA aneurysm is related with IPR during endovascular treatment of intracranial saccular aneurysm.•IPR incidence was 7.5% (6/80) in ruptured aneurysms and 2.5% (4/155) in unruptured aneurysms.•Understanding the mechanism of IPR in each stage and careful device manipulation are important to avoid IPR.