Kim Sung-Tae, Jin Sung-Chul, Jeong Hae Woong, Baek Jin Wook, Jeong Young Gyun
Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea.
Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2023 Dec;25(4):420-428. doi: 10.7461/jcen.2023.E2023.07.004. Epub 2023 Nov 29.
Intraprocedural rupture (IPR) is a fatal complication of endovascular coiling for cerebral aneurysms. We hypothesized that contrast leakage period may be related to poor clinical outcomes. This study aimed to retrospectively evaluate the relationship between clinical outcomes and contrast leakage period.
Data from patients with cerebral aneurysms treated via endovascular coiling between January 2010 and October 2018 were retrospectively assessed. The enrolled patient's demographic data, the aneurysm related findings, endovascular treatment and IPR related findings, rescue treatment, and clinical outcome were analyzed.
In total, 2,859 cerebral aneurysms were treated using endovascular coiling during the study period, with IPR occurring in 18 (0.63 %). IPR occurred during initial frame coiling (n=4), coil packing (n=5), stent deployment (n=7), ballooning (n=1), and microcatheter removal after coiling (n=1). Tear sites included the dome (n=14) and neck (n=4). All IPRs were controlled and treated with coil packing, with or without stenting. Flow arrest of the proximal balloon was not observed. Temporary focal neurological deficits developed in two patients (11.1%). At clinical follow-up, 14 patients were classified as modified Rankin Scale (mRS) 0, three as mRS 2, and one as mRS 4. The mean contrast leakage period of IPR was 11.2 min (range: 1-31 min). Cerebral aneurysms with IPR were divided into late (n=9, mean time: 17.11 min) and early (n=9, mean time: 5.22 min) control groups based on the criteria of 10 min of contrast leakage period. No significant between-group differences regarding clinical outcomes were observed after IPR (p=1).
In our series, all patients with IPR were controlled with further coil packing or stenting without proximal balloon occlusion within 31 min of contrast leakage. There was no difference in clinical outcomes when the long contrast leakage period group and short contrast leakage period group were compared.
术中破裂（IPR）是脑动脉瘤血管内栓塞治疗的一种致命并发症。我们推测造影剂渗漏时间可能与不良临床结局相关。本研究旨在回顾性评估临床结局与造影剂渗漏时间之间的关系。
回顾性评估2010年1月至2018年10月期间接受血管内栓塞治疗的脑动脉瘤患者的数据。分析纳入患者的人口统计学数据、动脉瘤相关发现、血管内治疗及IPR相关发现、抢救治疗和临床结局。
在研究期间，共2859例脑动脉瘤接受了血管内栓塞治疗，其中18例（0.63%）发生IPR。IPR发生于初始成篮（n = 4）、弹簧圈填塞（n = 5）、支架置入（n = 7）、球囊扩张（n = 1）及成篮后微导管拔除（n = 1）过程中。撕裂部位包括瘤顶（n = 14）和瘤颈（n = 4）。所有IPR均通过弹簧圈填塞控制和治疗，有或无支架置入。未观察到近端球囊血流停滞。2例患者（11.1%）出现短暂性局灶性神经功能缺损。临床随访时，14例患者改良Rankin量表（mRS）评分为0，3例为mRS 2，1例为mRS 4。IPR的平均造影剂渗漏时间为11.2分钟（范围：1 - 31分钟）。根据造影剂渗漏时间10分钟的标准，将发生IPR的脑动脉瘤分为晚期（n = 9，平均时间：17.11分钟）和早期（n = 9，平均时间：5.22分钟）对照组。IPR后两组临床结局无显著组间差异（p = 1）。
在我们的系列研究中，所有IPR患者在造影剂渗漏后within 31分钟内通过进一步弹簧圈填塞或支架置入控制，未进行近端球囊闭塞。长造影剂渗漏时间组和短造影剂渗漏时间组比较，临床结局无差异。
