Neuroradiology Unit, Hospital Reina Sofía, Córdoba, Spain.
Neurosurgery Department, Hospital Reina Sofía, Córdoba, Spain.
Acta Neurol Scand. 2022 Nov;146(5):598-603. doi: 10.1111/ane.13686. Epub 2022 Aug 17.
Intra- or peri-procedural aneurysm rupture is one of the most feared adverse effects associated with embolization. Our aim was to report the characteristics of patients suffering intra- or peri-procedural ruptures during embolization of cerebral aneurysms.
Between March 1994 and October 2021, 648 consecutive cerebral aneurysms were treated by endovascular procedure at our facility. Medical records were reviewed retrospectively with emphasis on procedure description, potential risk factors, and clinical outcomes related to intra- or peri-procedural rupture.
Of the 648 patients, 17 (2.6%) suffered an intra- or peri-procedural hemorrhagic event. The most common location was the anterior communicating artery. There was no significant difference between previously ruptured and unruptured aneurysms in the incidence of bleeding. In four patients, bleeding was evident within 24 h after the procedure. The clinical evolution at three months was poor and only four patients presented a positive evolution. There were 11 deaths (64.71%). Balloon remodeling was associated with an increased frequency of ruptures, while stenting was a safer treatment.
Aneurysmal rupture during endovascular therapy is unpredictable, and its occurrence can be devastating. The incidence is quite low although the outcome is frequently poor. Early detection and proper management, including prompt occlusion of the aneurysm, are important to achieve a positive outcome. Anterior communicating artery aneurysms and those treated with balloon catheters have a higher incidence of rupture. A small number of ruptures of uncertain origin occur that go unnoticed in digital subtraction angiograms.
术中或围手术期动脉瘤破裂是与栓塞相关的最可怕的不良后果之一。我们的目的是报告在栓塞脑动脉瘤期间发生术中或围手术期破裂的患者的特征。
1994 年 3 月至 2021 年 10 月期间，我们医院对 648 例连续的脑动脉瘤进行了血管内治疗。回顾性审查病历，重点是手术描述、潜在的危险因素以及与术中或围手术期破裂相关的临床结果。
在 648 例患者中，17 例（2.6%）发生术中或围手术期出血事件。最常见的部位是前交通动脉。在出血发生率方面，先前破裂和未破裂的动脉瘤之间没有显著差异。在 4 例患者中，出血发生在手术后 24 小时内。三个月时的临床转归较差，只有 4 例患者出现阳性转归。有 11 例死亡（64.71%）。球囊重塑与破裂频率增加相关，而支架置入术是一种更安全的治疗方法。
血管内治疗期间动脉瘤破裂是不可预测的，其发生可能是毁灭性的。尽管结果常常很差，但发生率相当低。早期发现和适当的管理，包括及时闭塞动脉瘤，对于实现良好的结果很重要。前交通动脉动脉瘤和用球囊导管治疗的动脉瘤破裂发生率较高。少数来源不明的破裂在数字减影血管造影中未被发现。
