INTRA-ANEURYSMAL PRESSURE CHANGES DURING ANGIOGRAPHY IN COIL EMBOLIZATION

BACKGROUND Although elevation of blood pressure in aneurysms induced b y injection of contrast medium has been postulated as a major cause of rerupture of ruptured cerebral aneurysms during angiography, no study has proved the elevation of intra-aneurysmal pressure because of diff iculty in measuring the intra-aneurysmal pressure during angiography, The present study demonstrated intraaneurysmal pressure to be raised b y injection of contrast medium, using a microcatheter introduced into aneurysms. METHODS To confirm the accuracy of pressure measurement thr ough a microcatheter, we measured intra-aneurysmal pressure in a plast ic model of an artery and an aneurysm during and after injection of co ntrast medium through a microcatheter and a needle inserted into the a neurysm, In a clinical study, intra-aneurysmal pressures were measured through the microcatheter in nine cerebral aneurysms of seven patient s. RESULTS In the model experiment, changes in the pressure measured t hrough the microcatheter correlated well with those observed through t he needle. In the clinical study, intra-aneurysmal systolic pressures increased by 5-23 mm Hg immediately after injection of contrast medium for 1-3 s in four basilar tip, three internal carotid-ophthalmic, and one middle cerebral artery aneurysm, whereas no pressure change was o bserved in a posterior cerebral artery aneurysm, Systemic blood pressu re during angiography remained unchanged in all cases. CONCLUSIONS Thi s abruptly elevated intra-aneurysmal pressure by injection of contrast medium might cause rerupture of an aneurysm soon after rupture of the aneurysm, especially when the rupture site is fragile. (C) 1997 by El sevier Science Inc.