Aneurysmal Rupture during Embolization with Guglielmi Detachable Coils: Causes, Management and Outcome Dae Hyun Hwang M.D.,PhD.,YoungHwan Ko M.D., Kook Seon Kim,M.D., Ik Won Kang M.D.,Ph.D., Seong Tae Park* M.D.,Ph.D., In Soo Kim,**M.D., Choon Woog Hur**M.D.,Ph.D. Hangang Sacred Heart Hospital, Hallym University, SoonChunHyang University Hospital *,Myung-gi Saint Marry Hospital **,Seoul,Korea

BACKGROUND Aneurysmal rupture during endovascular treatment is one of the most feared complications of endovascular aneurysm therapy.

BACKGROUND Rupture during Treatment of Recently Ruptured Aneurysms with Guglielmi Electrodetachable Coils Fre´de´ric Ricolfi et al. AJNR Am J Neuroradiol 19:1653–1658, October 1998 Retrospective review of 91 aneurysms 4 Perforated aneurysms (4.39%) Two involved the anterior communicating artery, one the posterior inferior communicating artery, one the basilar artery AJNR Am J Neuroradiol 19:1653–1658, October 1998

BACKGROUND Perforation was accompanied by a severe increase in arterial pressure Major complications : in 2 patients, whose aneurysms were located in the posterior fossa One patient : expired The other : improved after emergency ventriculostomy AJNR Am J Neuroradiol 19:1653–1658, October 1998

BACKGROUND Management of aneurysmal perforation Continued coiling, antagonists of heparin (protamine sulfate) If these critical conditions persist intracranial pressure must be decreased as quickly as possible. : can be achieved by rapid ventriculostomy Emergency ventriculostomy is effective in managing intracranial hypertension. AJNR Am J Neuroradiol 19:1653–1658, October 1998

Case 4: 49-year-old woman Ventriculostomy : 15min 4-mm saccular aneurysm with a 3-mm neck of the basilar a. large neck,  3-mm-balloon catheter rupture during temporary deflation of the balloon dense mesh of coils within aneurysmal cavity Postembolization AJNR Am J Neuroradiol 19:1653–1658, October 1998

BACKGROUND Aneurysmal Rupture during Embolization with Guglielmi Detachable Coils: Causes, management, and Outcome Arnd Doerfler, et al. AJNR Am J Neuroradiol 22:1825–1832, November/December acutely ruptured cerebral aneurysms with GDCs Patients with aneurysmal rupture occurring during embolization were identified. AJNR Am J Neuroradiol 22:1825–1832, November/December 2001

BACKGROUND Intraprocedural aneurysmal rupture in 5 patients (3.04%) Endovascular packing was continued in all patients. One patient died as a result of the aneurysmal rupture. No negative long-term effects were observed in the remaining four patients. AJNR Am J Neuroradiol 22:1825–1832, November/December 2001

PURPOSE To determine the frequency, causes, management, and outcome of aneurysmal rupture that occurred during treatment with Guglielmi detachable coils (GDCs) in an unselected series of patients with ruptured cerebral aneurysms.

METHODS Between July 1999 and May 2009, we treated 221 acutely ruptured cerebral aneurysms with GDCs. All charts were reviewed, and patients with aneurysmal rupture occurring during embolization were identified.

Case 1 In one patient, rupture was due to guidewire perforation of the wall (anterior communicating artery aneurysm).

Case 2 In one patient, the microcatheter itself perforated the aneurysm(P-com aneurysm).

Case 3 In one patient, rupture occurred during placement of the first coil. Endovascular packing was continued in one patient.

M/72,right MCA Aneurysm

4mmx8cm coil,ruptured right MCA and recoiling

2mmx4cm, 2mmx4cm

2mmx2cm, 2mmx2cm

Post CT (08.08)

follow up (10.01)

Case 4 In another patient, rupture occurred during placement of the last coil. Last coil detaching was continued in one patient.

>

mmx5cm(MTI),2mmx3cm(MTI),

2mmx2cm(GDC)

2mmx1cm(MTI)

3.27,07. Post coiling F/U CT

RESULTS Four patients had an intraprocedural aneurysmal rupture.

RESULTS Two patients died as a result of the aneurysmal rupture. No negative long-term effects were observed in the remaining two patients.

RESULTS In summary, we observed intraprocedural aneurysmal rupture in 1.8% of our patients, with a mortality rate of 50% and no long-term morbidity.

CONCLUSION Aneurysmal rupture during endovascular treatment with GDCs is a rare event; clinical severity may be variable. Embolization of the aneurysm can be continued in most cases, and 50% of patients with treatment-related subarachnoid hemorrhage survive without serious sequelae. AJNR Am J Neuroradiol 22:1825–1832, November/December 2001