Intraprocedural rupture of unruptured cerebral aneurysms during coil embolization: A single center experience

Abstract Objective The incidence of intraprocedural rupture (IPR) during endovascular coiling is reported to range from 2% to 5%. In this study, we reviewed the single center experiences of IPR during coil embolization for unruptured intracranial aneurysm. Methods At our institution, 849 patients were treated with endovascular therapy for unruptured intracranial aneurysm between January 2011 and April 2016. Ten (1.18%) of these patients had documented IPR. We reviewed the medical data to evaluate the characteristics of the aneurysms, angiographic findings related to rupture, management, and outcomes. Results Among the 10 patients, there were four internal carotid artery aneurysms, three anterior communicating artery aneurysms, two basilar tip aneurysms, and one middle cerebral artery aneurysm. The probable mechanism of IPR in seven patients was focal coil mass distension. Two patients underwent rupture due to injury by a microcatheter tip that was related to device-device interaction. Increased intra-arterial pressure induced by contrast injection was suspected as a cause of rupture in one patient who had no other clear etiology. In all cases, rapid occlusion of the point suspected of leakage was performed and final angiography showed complete obliteration of the aneurysm. Two patients showed neurological deterioration after the procedure. The modified Rankin scale at 6 month follow-up was scored 0 in 7 of the patients. Conclusion The incidence of IPR during endovascular coiling for unruptured aneurysm is relatively low, and early detection followed by rapid occlusion of the aneurysm can lead to a benign clinical course in most cases.