The Risk Factors For Rerupture Of Ruptured Intracranial Aneurysm During Intravascular Embolization

Objective:To study the risk factors of intraprocedural re-rupture(IPR)of ruptured intracranial aneurysms and the emergency management on this event.Methods: 678 patients with ruptured intracranial aneurysm that received intravascular embolization were included in this study,including 20 cases that suffered rerupture of intracranial aneurysm during the surgery.Following data were recorded: gender,age,history of hypertention,history of diabetes,atherosclerosis of intracranial artery,Hunt—Hess grade,aneurysm size,aneurysm location,feature of aneurysmal neck,vasospasm,the timing of endovascular treatment after SAH,modality of treatment and complications(intraoperative rupture of aneurysms).The data above were investigated in univaliate analysis and multivariate logistic regression model to determine whether they were associated with complications of aneurismal coiling.Statistical analysis was performed with the SPSS statistical package(SPSS 1 7.0).A value<0.05 was considered statistical significant.The risk factors for intraoperative rerupture were analyzed by univariate and multivariate analyses.And the emergency management of IPR was concluded in 20 patients with IPR.Results: A total of 678 patients with 678 ruptured aneurysms were included in this study.Of them,360(53%)were women and 318(47%)were men.The mean age of the patients was 56.2+8.6 years.Hunt-Hess grade on admission was as follow: I-III543 cases(90%),IV-V 70 cases(10%).A total of 678 ruptured aneurysms were coiled,and 595 aneurysms(87.8%)were located in the anterior circulation and 83(12.2%)in the posterior circulation.According to aneurysm size,the aneurysms were classified as:tiny aneurysms 97(14.3%),small 520(76.7%),large 61(8.9%).Intraoperative rupture of aneurysms occurred in 20 patients(3.5 %).The morbidity of IPR was 2.94% and mortality was 25%.12 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,8 of them presented with different degrees of disability and 7 were fully recovered.Vasospas(?2=6.119,P <0.05)?atherosclerosis(?2=4.673,P <0.05)and aneurysm size(?2=11.372,P <0.05)were the risk factors for intraoperative rerupture;while sex,age,history of hypertension,history of diabetes mellitus,Hunt-Hess grade,characteristics of the aneurysmal neck,surgical procedure and surgical time were not significantly correlated with incidences of rerupture of intracranial aneurysm.Conclusion: vasospasm,atherosclerosis,and micro-aneurysm are the risk factors for rerupture of intracranial aneurysm during intravascular embolization.Rapid completion of coiling combined with immediate reversal of heparin anticoagulation is confirmed to be the best strategy in our series.