Clinical Study Of Intraprocedural Rerupture During Coil Embolization Of Ruptured Intracranial Aneurysms

Objective: This study aimed to investigate the risk factors,way of prevention and treatment,management of postprocedual,and prognosis of intraprocedural rerupture(IPR)during coil embolization of ruptured intracranial aneurysms,and to provide foundation for clinical treatment and management of periprocedural.Methods: We retrospectively analyzed the records of patients with ruptured intracranial aneurysms treated with endovascular coiling embolization in Neurosurgical Department of Affiliated Hospital of Southwest Medical University between August 2013 and August 2016.Univariate analysis and multivariate logistic regression model were adopted to investigate the relation between general data,image data,procedure-related data and IPR,and to trace the risk factors of IPR.Then we further analyze the related factors affecting prognosis.Results: The records of 215 patients were enrolled to this series,including 102(47.4%)males and 113(52.6%)females,with the mean age of 55.6±10.0.Hunt-Hess grade on admission was as follow,? in 41(19.1%)patients,? in 108(50.2%)patients,? in 54(25.1%)patients,? in 12(5.6%)patients.Patients who with hypertension were 106(49.3%),with smoke 52(24.2%).The modified fisher scale was used to evaluate initial CT image of patients on admission,? in 49(22.8%),? in 59(27.4%),? in 70(32.6%),? in 37(17.2%).In our series,there were 190(88.4%)aneurysms in anterior circulation,25(11.6%)aneurysms in posterior circulation.The mean size of aneurysms was 5.7±2.6mm.Regular sac aneurysms were 136(63.3%),irregular sac aneurysms were 43(20.0%),multilobulated or daughter sac were 36(16.7%).The time between aneurysm rupture and coil embolization within 3 days were 80(37.2%)patients,between 4 and 10 days were 88(40.9%),beyond 10 days were 47(21.9%).Patients who received coiling alone were 108(50.2%),stent-assisted coiling were 95(44.2%),balloon-assisted coiling were 12(5.6%).Initial angiographic results showed complete occlusion in 175(81.4%),near occlusion in 32(14.9%),and partial occlusion in 8(3.7%).There were sixteen patients(7.4%)experienced IPR during coil embolization in our series.Univariate analysis showed that small aneurysms(P=0.004),multilobulation or daughter sac aneurysms(P=0.033),intermediate coiling(P=0.019),and intraprocedural cerebral vasospasm(P=0.016)carried a higher risk of procedure-related rerupture.And multivariate logistic regression analysis showed that small aneurysms(OR,4.259;95%CI,1.107-16.393;P=0.035),multilobulation or daughter sac aneurysms(OR,7.615;95%CI,1.857-31.234;P=0.005),intermediate coiling(OR,3.613;95%CI,1.106-11.809;P=0.033),and intraprocedural cerebral vasospasm(OR,5.731;95%CI,1.448-22.683;P=0.013)were independent risk factors for IPR.Patients who experienced IPR were more likely to develop symptomatic vasospasm(P=0.021)and obtain poor prognosis(P=0.002)than the others.But IPR didn't increase the risk of surgery-dependent hydrocephalus.IPR's overall disability and death rate was 37.5%.Conclusion: The IPR during coil embolization of ruptured intracranial aneurysms with high incidence rate,high disability and death rate,seriously affected the prognosis of patients.Small aneurysms,multilobulation or daughter sac aneurysms,intermediate coiling,intraprocedural cerebral vasospasm were independent risk factors of IPR.Patients who experienced IPR were more likely to develop symptomatic vasospasm.Effective preprocedural assessment,prevention,timely and accurate disposal and postprocedual careful management helped to reduce this complication and improve patients' prognosis.