Rupture during coiling of intracranial aneurysms: Predictors and clinical outcome

Kocur, Damian; Przybyłko, Nikodem; Bazowski, P; Baron, Jan

doi:10.1016/j.clineuro.2018.01.006

Cited by 19 publications

(22 citation statements)

References 23 publications

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“…Although IPRs have resulted from various problems, such as coil protrusion and microcatheter perforation,11 the IPRs in this study appeared at a rate of 4.1%, which was similar to those using our previous JR-NET and JR-NET2 data, and higher than that of unruptured aneurysms based on our JR-NET and JR-NET2 data 12. While there was no significant correlation between an IPR and the prognosis in previous reports,13 14 IPR was a factor related to poor prognosis, which was similar to our previous JR-NET and JR-NET2 data. This difference may be because the timing of the data was slightly older, although balloon catheters are now able to access more distal areas than previously and reduce intraprocedural hemorrhage by the inflation around the aneurysm neck.…”

Section: Discussionsupporting

confidence: 88%

Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms

Imamura

Sakai

Satow

et al. 2020

J NeuroIntervent Surg

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Background and purposeThe risk factors for adverse events for example, intraprocedural rupture (IPR), ischemic complication within 24 hours, and rebleeding after endovascular coil embolization for a ruptured cerebral aneurysm remain unclear. The aim of this study was to identify significant associated risk factors.MethodsWe retrospectively evaluated data from 5358 patients listed on the Japanese Registry of Neuroendovascular Therapy 3 during 2010–2014.ResultsIPR, ischemic complications, and rebleeding occurred during or after 221 (4.1%), 226 (4.2%), and 63 (1.2%) treatments, respectively. All of the adverse events were significantly associated with the patients’ poor outcomes at 30 days. Multivariate analysis revealed the factors independently related to these adverse events as follows: (1) for IPR: female sex, bifurcation type, <5 mm aneurysm, emergent surgery, local anesthesia, a balloon-assisted technique; (2) for an ischemic complication: poor World Federation World Federation of Neurological Societies (WFNS) grade, wide neck, and stent-assisted technique; (3) for rebleeding: poor WFNS grade, bifurcation type, wide neck, and body filling as the initial result.ConclusionsKnowledge of the risk factors of endovascular coil embolization and paying attention to them are essential for patients’ safe treatment and good outcomes.

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Section: Discussionsupporting

confidence: 88%

Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms

Imamura

Sakai

Satow

et al. 2020

J NeuroIntervent Surg

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“…According to the review of the Cerebral Aneurysm Re-rupture After Treatment (CARAT) study, the coiling-related IOR occurred in 5% of patients, and IOR was associated with 64% rate of periprocedural death and disability [38]. Recently, Kocur et al [39] summarized previous literature and showed that the incidence of IOR ranges from 1 to 8.7% and the risk of permanent neurologic disability and death related to IOR is up to 63%. There are many risk factors for the IOR, such as ruptured aneurysms, small aneurysms size, device size, race, and lower initial Hunt and Hess Grade [38][39][40][41], even intra-aneurysmal contrast media injection and sudden rise in arterial pressure may also induce IOR [39].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Kocur et al [39] summarized previous literature and showed that the incidence of IOR ranges from 1 to 8.7% and the risk of permanent neurologic disability and death related to IOR is up to 63%. There are many risk factors for the IOR, such as ruptured aneurysms, small aneurysms size, device size, race, and lower initial Hunt and Hess Grade [38][39][40][41], even intra-aneurysmal contrast media injection and sudden rise in arterial pressure may also induce IOR [39]. In this study, the IOR occurred in 14.6% of patients, such high IOR rate in the two groups probably contributes to the experience of the endovascular neurosurgeon and the aneurysms status.…”

Section: Discussionmentioning

confidence: 99%

The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling: a case-control study

et al. 2020

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Background Incomplete aneurysmal occlusion is a common feature of immediate posttreatment angiography. The safety and outcomes of acutely ruptured intracranial aneurysms (RIAs) with incomplete occlusion after stent-assisted coiling (SAC) and no-stent coiling (NSC) have not been well clarified. Progressive occlusion of stents can promote the complete occlusion of intracranial aneurysms (IAs), but it remains to be determined if progressive occlusion in acutely RIAs with incomplete occlusion after coiling may be enhanced by protective stenting. This study aimed to evaluate the safety and outcomes of those aneurysms after SAC and NSC; And to discover whether the stents can promote progressive aneurysm occlusion in such lesions or not. Methods We reviewed 199 patients with acutely RIAs underwent endovascular coiling and developed incomplete occlusion in the past seven years. The patients’ clinical and imaging information were recorded and analyzed. Univariate and multivariate analyses were performed to determine the association of recurrence rate with potential risk factors. Results SAC group had wider aneurysms neck (3.471 mm vs 2.830 mm, P = 0.009) and smaller dome-to-neck ratio (1.536 vs 2.111, P = 0.001) than in NSC group. There was no significant difference between the two groups in total procedure-related complications rate (31.7% vs 23.5%, P = 0.195), procedure-related mortality (6.9% vs 2.0%, P = 0.170) and modified Rankin Scale (mRS) score at 6-month follow-up (P > 0.05). However, SAC group had significantly higher ischemic complications rate (21.8% vs 8.2%, P = 0.007) and complete occlusion rate (65.6% vs 48.3%, P = 0.020), and lower recurrence rate (15.6% vs 28.1%, P = 0.042) than NSC group based on 6-month follow-up angiograms. Additionally, Multivariable analysis showed NSC was an independent risk factor for aneurysm recurrence (Odds Ratio [OR]: 4.061; P = 0.018). Conclusions Acutely RIAs with incomplete occlusion after SAC is associated with higher complications rate and mortality, but has an acceptable safety profile and similar clinical outcome compared to NSC, as well as gives patients superior angiography outcome by progressive occlusion of stents.

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“…Intracranial aneurysms (IAs) are diseases with high mortality and morbidity rates, which are commonly caused by subarachnoid hemorrhage (SAH) (Bjorkman et al, 2017). The prevalence rate of IAs is about 2-3% in the general population all around the world (Kocur et al, 2018). As suggested by histological studies, cerebral aneurysms present with loss of internal elastic lamina of vascular wall; meanwhile, the loss of elastic fibers also enhances the outpouching of remaining vascular layers (Hamada et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

miR-34a regulates phenotypic modulation of vascular smooth muscle cells in intracranial aneurysm by targeting CXCR3 and MMP-2

et al. 2021

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Rupture during coiling of intracranial aneurysms: Predictors and clinical outcome

Cited by 19 publications

References 23 publications

Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms

Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms

The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling: a case-control study

miR-34a regulates phenotypic modulation of vascular smooth muscle cells in intracranial aneurysm by targeting CXCR3 and MMP-2

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