From the Departments of Neurosurgery (H.H.C.), Dongguk University College of Medicine, Dongguk University Hospital, Ilsan, Korea.
Departments of Neurosurgery (E.J.H., W.-S.C., J.E.K., H.-S.K.).
AJNR Am J Neuroradiol. 2017 Nov;38(11):2126-2130. doi: 10.3174/ajnr.A5344. Epub 2017 Aug 31.
Procedural rupture of an intracranial aneurysm is a devastating complication in endovascular treatment. The purpose of this study was to evaluate the clinical outcomes of patients with procedural rupture of unruptured saccular intracranial aneurysms compared with those with spontaneously ruptured aneurysms.
A retrospective review was performed for 1340 patients with 1595 unruptured saccular intracranial aneurysms that underwent endovascular coil embolization between February 2010 and December 2014. The clinical outcomes of patients with procedural rupture of unruptured saccular intracranial aneurysms were compared with those of 198 patients presenting with spontaneously ruptured aneurysms.
In this series, procedural rupture developed in 19 patients (1.4% per patient and 1.2% per aneurysm), and the morbidity related to procedural rupture was 26.3% (95% confidence interval, 8.5%-61.4%) with no mortality. Hunt and Hess scale grades and hospitalization days of patients with procedural rupture were equivalent to those of patients presenting with spontaneous aneurysm rupture. Subsequent treatment procedures after hemorrhage (including lumbar drainage, extraventricular drainage, decompressive craniectomy, and permanent shunt) showed no difference between the 2 groups. The hemorrhage volumes were smaller in the procedural-rupture group ( = .03), and the endovascular vasospasm therapies tended to be more frequently required in the spontaneous aneurysm-rupture group ( = .08). At postictus 6 months, the proportion of modified Rankin Scale scores of ≥2 were lower in the procedural-rupture group (5.3% versus 26.8%, = .049). In multivariate analysis, spontaneous aneurysm rupture was a significant risk factor for worse clinical outcome (OR = 14.9; 95% CI, 1.2-193.1; = .039).
This study showed better clinical outcomes in the procedural-rupture group. Even though there is a potential chance of aneurysm rupture during treatment, the clinical outcomes after procedural bleeds seem to be more favorable than those of spontaneous rupture.
血管内治疗过程中，颅内动脉瘤破裂是一种灾难性的并发症。本研究旨在评估与自发性破裂动脉瘤相比，未破裂囊状颅内动脉瘤血管内治疗过程中破裂患者的临床结局。
回顾性分析了 2010 年 2 月至 2014 年 12 月期间 1340 例 1595 个未破裂囊状颅内动脉瘤患者的资料。比较了未破裂囊状颅内动脉瘤治疗过程中破裂患者的临床结局与 198 例自发性破裂动脉瘤患者的临床结局。
本研究中，19 例（1.4%/患者，1.2%/动脉瘤）发生治疗过程中破裂，与治疗过程中破裂相关的发病率为 26.3%（95%置信区间，8.5%-61.4%），无死亡病例。治疗过程中破裂组和自发性破裂组的 Hunt 和 Hess 分级及住院天数相当。两组患者出血后的后续治疗（包括腰椎引流、脑室外引流、减压性颅骨切除术和永久性分流术）无差异。治疗过程中破裂组的出血量较小（ =.03），自发性破裂组更倾向于进行血管痉挛治疗（ =.08）。发病后 6 个月时，治疗过程中破裂组改良 Rankin 量表评分≥2 的比例较低（5.3%比 26.8%， =.049）。多因素分析显示，自发性破裂是临床结局较差的显著危险因素（OR=14.9；95%CI，1.2-193.1； =.039）。
本研究显示治疗过程中破裂组的临床结局更好。尽管在治疗过程中存在动脉瘤破裂的潜在风险，但治疗后出血的临床结局似乎优于自发性破裂。
