RUPTURE DURING TREATMENT OF RECENTLY RUPTURED ANEURYSMS WITH GUGLIELMI ELECTRODETACHABLE COILS

BACKGROUND AND PURPOSE: We describe four cases of aneurysmal rupture d uring embolization with Guglielmi electrodetachable coils (GDCs) in an attempt to identify those aneurysms whose rupture during embolization represents a life-threatening risk; our emphasis is on emergency mana gement, in particular, ventriculostomy. METHODS: Medical records were reviewed retrospectively for 91 aneurysms treated with GDCs 0 to 21 da ys after subarachnoid hemorrhage, Rupture was ascertained by the prese nce of extravascular effusion of contrast medium. RESULTS: Of the perf orated aneurysms, two involved the anterior communicating artery, one the posterior inferior communicating artery, and one the basilar arter y. Only two patients, whose aneurysms were located in the posterior fo ssa, had major complications (arterial hyperpressure, mydriasis, angio graphically documented circulatory arrest or slowing). One of these pa tients died and the other improved after emergency ventriculostomy. CO NCLUSION: Aneurysmal perforation during embolization may be accompanie d by severe intracranial hypertension, which causes either a decrease or arrest of cerebral perfusion, the duration of which determines clin ical outcome. Emergency ventriculostomy (which should be performed in the angiographic suite) is an effective means to reduce intracranial p ressure. Recognition of aneurysms associated with a high risk of morta lity by rupture in the course of embolization (recently ruptured small aneurysms, posterior fossa aneurysms, associated ventricular dilatati on, massive cisternal hemorrhage) and use of proper logistics should e nsure the effective management of this devastating complication.