Rupture of intracranial aneurysms during endovascular coiling: Management and outcomes

OBJECTIVE: In this study, the incidence, etiologies, and management with re spect to clinical outcome of patients with iatrogenic aneurysmal rupture du ring attempted coil embolization of intracranial aneurysms are reviewed. METHODS: A retrospective analysis was conducted of 274 patients with intrac ranial aneurysms treated with Guglielmi detachable coils over a 6-year peri od from 1994 to 2000. Patient medical records were examined for demographic data, aneurysm location, the number of coils deployed preceding and after aneurysmal rupture, the etiology of the rupture, and the clinical status on admission and at the time of discharge. RESULTS: Of 274 patients with intracranial aneurysms treated with coil embo lization, six (2%) had an intraprocedural rupture. Of these six, two were w omen and four were men. The mean age was 67 years (range, 52-85 yr). Mean f ollow-up time was 8 months (range, 0-25 mo). Aneurysmal rupture resulted fr om detachment of the last coil in three patients, detachment of the third c oil (of four) in one patient, and insertion of the first coil in another pa tient. In one patient, the aneurysmal rupture was a result of catheter adva ncement before detachment of the last coil. The Glasgow Outcome Scale score at last follow-up examination was 1 in two patients, 2 in two patients, an d 5 in two patients. CONCLUSION: The rate of rupture of aneurysms during coil embolization is ap proximately 2 to 4%. The clinical outcome may be related to the timing of t he rupture and the number of coils placed before rupture. If extravasation of contrast agent is seen, which suggests intraprocedural rupture, further coil deposition should be attempted if safely possible.