OBJECT: Procedure-related rupture during endovascular therapy of intracranial aneurysms is associated with a mortality rate of more than one third. Previously ruptured aneurysms are a known risk factor for procedure-related rupture. The objective of this study was to evaluate whether very small, ruptured aneurysms are associated with more frequent intraprocedural ruptures. METHODS: This was a retrospective cohort study in which the investigators examined consecutive ruptured aneurysms treated with coil embolization at a single institution. The study was approved by the institutional review board. Very small aneurysms were defined as < or = 3 mm. Procedure-related rupture was defined as contrast extravasation during treatment. Univariate analysis with the Fisher exact test and the Mann-Whitney U test was performed. RESULTS: Between August 1992 and January 2007, 682 aneurysms were selectively treated with coils in 668 patients. Procedure-related rupture occurred in 7 (11.7%) of 60 aneurysms < or = 3 mm, compared with 14 (2.3%) of 622 aneurysms > 3 mm (relative risk 5.2, 95% confidence interval 2.2-12.8; p < 0.001). Among cases with procedure-related rupture, inflation of a compliant balloon was associated with better outcome (Glasgow Outcome Scale Score > or = 4) compared with patients treated without balloon assistance (5 of 5 compared with 7 of 16; p = 0.05). Death resulting from procedure-related rupture occurred in 8 (38%) of 21 patients, and a vegetative state occurred in 1 patient. Clinical outcome was good in the other 12 patients (57%). CONCLUSIONS: Endovascular coil embolization of very small (< or = 3 mm) ruptured cerebral aneurysms is 5 times more likely to result in procedure-related rupture compared with larger aneurysms. Balloon inflation for hemostasis may be associated with better outcome in the event of intraprocedural rupture and merits further study.
OBJECT: Procedure-related rupture during endovascular therapy of intracranial aneurysms is associated with a mortality rate of more than one third. Previously ruptured aneurysms are a known risk factor for procedure-related rupture. The objective of this study was to evaluate whether very small, ruptured aneurysms are associated with more frequent intraprocedural ruptures. METHODS: This was a retrospective cohort study in which the investigators examined consecutive ruptured aneurysms treated with coil embolization at a single institution. The study was approved by the institutional review board. Very small aneurysms were defined as < or = 3 mm. Procedure-related rupture was defined as contrast extravasation during treatment. Univariate analysis with the Fisher exact test and the Mann-Whitney U test was performed. RESULTS: Between August 1992 and January 2007, 682 aneurysms were selectively treated with coils in 668 patients. Procedure-related rupture occurred in 7 (11.7%) of 60 aneurysms < or = 3 mm, compared with 14 (2.3%) of 622 aneurysms > 3 mm (relative risk 5.2, 95% confidence interval 2.2-12.8; p < 0.001). Among cases with procedure-related rupture, inflation of a compliant balloon was associated with better outcome (Glasgow Outcome Scale Score > or = 4) compared with patients treated without balloon assistance (5 of 5 compared with 7 of 16; p = 0.05). Death resulting from procedure-related rupture occurred in 8 (38%) of 21 patients, and a vegetative state occurred in 1 patient. Clinical outcome was good in the other 12 patients (57%). CONCLUSIONS: Endovascular coil embolization of very small (< or = 3 mm) ruptured cerebral aneurysms is 5 times more likely to result in procedure-related rupture compared with larger aneurysms. Balloon inflation for hemostasis may be associated with better outcome in the event of intraprocedural rupture and merits further study.
Authors: Peter Kan; Parham Yashar; Ciprian N Ionita; Amit Jain; Stephen Rudin; Elad I Levy; Adnan H Siddiqui Journal: J Neurointerv Surg Date: 2012-01-21 Impact factor: 5.836
Authors: Tim E Darsaut; Vincent Costalat; Igor Salazkin; Sara Jamali; France Berthelet; Guylaine Gevry; Daniel Roy; Jean Raymond Journal: Interv Neuroradiol Date: 2014-06-17 Impact factor: 1.610