Object: Intraprocedural rerupture (IPR) of intracranial aneurysms during coil embolization is associated with significant periprocedural disability and death. However, whether this morbidity and mortality are secondary to an increased risk of vasospasm and hydrocephalus is unknown. The authors undertook this study to determine the in-hospital and long-term neurological outcomes for patients with aneurysmal subarachnoid hemorrhage (SAH) treated with coil embolization who suffer aneurysm rerupture during treatment.
Methods: The records of 156 patients admitted with SAH from previously untreated, ruptured, intracranial aneurysms and treated with endovascular coiling between January 2007 and January 2014 were retrospectively reviewed. Twelve patients (7.7%) experienced IPR during coil embolization.
Results: Compared with the cohort of patients with uncomplicated coil embolization procedures, patients with aneurysm rerupture were more likely to require external ventricular drain (EVD) placement (91.7% vs 58.3%, p = 0.02) and postprocedural EVD placement (36.4% vs 7.1%, p = 0.01), to undergo permanent ventriculoperitoneal shunt placement (50.0% vs 18.8%, p = 0.02), to develop symptomatic vasospasm (50.0% vs 18.1%, p = 0.02), and to have longer lengths of hospital stay (median 21.5 days vs 15.0 days, p = 0.04). Admission Hunt and Hess, modified Fisher, and Barrow Neurological Institute grades did not differ between the 2 cohorts, nor did long-term functional neurological outcomes as assessed by the modified Rankin Scale.
Conclusions: Intraprocedural rerupture during coil embolization for ruptured intracranial aneurysms is associated with an increased risk of symptomatic vasospasm and need for temporary and permanent cerebrospinal fluid diversion for hydrocephalus.
Keywords: BNI = Barrow Neurological Institute; BRAT = Barrow Ruptured Aneurysm Trial; CARAT = Cerebral Aneurysm Rerupture After Treatment; EVD = external ventricular drain; ICP = intracranial pressure; ICU = intensive care unit; IOR = intraoperative aneurysm rupture; IPR = intraprocedural rerupture; ISAT = International Subarachnoid Aneurysm Trial; MGH = Massachusetts General Hospital; SAH = subarachnoid hemorrhage; SBP = systolic blood pressure; TCD = transcranial Doppler; VP = ventriculoperitoneal; aSAH = aneurysmal SAH; aneurysm; coil embolization; endovascular neurosurgery; hydrocephalus; intraprocedural rupture; mRS = modified Rankin Scale; subarachnoid hemorrhage; vascular disorders; vasospasm.