Rupture of intracranial aneurysms during endovascular coiling: Management and outcomes

被引:74
作者
Levy, E
Koebbe, CJ
Horowitz, MB
Jungreis, CA
Pride, GL
Dutton, K
Kassam, A
Purdy, PD
机构
[1] Univ Pittsburgh, Med Ctr, Dept Neurosurg, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Med Ctr, Dept Radiol, Pittsburgh, PA 15213 USA
[3] Univ Texas, SW Med Ctr, Dept Radiol, Dallas, TX 75235 USA
关键词
aneurysm; coil embolization; endovascular; Guglielmi detachable coils;
D O I
10.1097/00006123-200110000-00005
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: In this study, the incidence, etiologies, and management with respect to clinical outcome of patients with iatrogenic aneurysmal rupture during attempted coil embolization of intracranial aneurysms are reviewed. METHODS: A retrospective analysis was conducted of 274 patients with intracranial aneurysms treated with Guglielmi detachable coils over a 6-year period 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 embolization, six (2%) had an intraprocedural rupture. Of these six, two were women and four were men. The mean age was 67 years (range, 52-85 yr). Mean follow-up time was 8 months (range, 0-25 mo). Aneurysmal rupture resulted from detachment of the last coil in three patients, detachment of the third coil (of four) in one patient, and insertion of the first coil in another patient. In one patient, the aneurysmal rupture was a result of catheter advancement 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, and 5 in two patients. CONCLUSION: The rate of rupture of aneurysms during coil embolization is approximately 2 to 4%. The clinical outcome may be related to the timing of the 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.
引用
收藏
页码:807 / 811
页数:5
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