Factors responsible for poor outcome after intraprocedural rerupture of ruptured intracranial aneurysms: Identification of risk factors, prevention and management on 18 cases

摘要

Purpose: The paper mainly involved the retrospective approach to risk factors of intraprocedual rerupture (IPR) and illustration of our empirical prevention and management on this event as well as its postembolization outcomes evaluation. Materials and methods: Endovascular treatment was performed in 1308 patients with 1308 ruptured intracranial aneurysms, and IPR occurred in 18 cases. We retrospectively reviewed their clinical records and images, and analysis risk factors of IPR by using multivariate logistic regression. Results: The morbidity of IPR was 1.38% and mortality was 33.33%. Nine patients survived from rapid completion of coiling with immediate reversal of heparin anticoagulation with protamine sulfate, and 3 from emergent external ventricular drainage (EVD). However, 9 of them presented with different degrees of disability and 3 were fully recovered. Small aneurysms (diameter ≤ 3.0 mm) (OR 284.212, 95% C.I. 17.368-4650.780, P = 0.000), atherosclerosis (OR 7.866, 95% C.I. 1.113-55.570, P = 0.039), Fisher Grade III (OR 82.099, 95% C.I. 1.563-431.696, P = 0.029), vasospasm (grade I) (OR 32.269, 95% C.I. 2.393-435.132, P = 0.009) and vasospasm (grade II) (OR 30.238, 95% C.I. 1.770-516.552, P = 0.019) are risk factors of IPR. Aneurysms at proximal part of internal carotid artery (ICA), bifurcation and basilar artery (BA) stem (OR 0.003, 95% C.I. 0.000-0.101, P = 0.001) and Hunt and Hess Grade II (OR 0.010, 95% C.I. 0.000-0.346, P = 0.011) are identified as protective factors. Conclusions: Small aneurysms, atherosclerosis, Fisher Grade of SAH and cerebral vasospasm are the predictors of IPR. Aneurysms at proximal part of ICA bifurcation and BA stem and Hunt and Hess Grade II are less associated with IPR. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation is confirmed to be the best strategy in our series.