Artikel
Per-procedural aneurysm re-rupture in relation to timing of endovascular treatment and outcome
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Autoren
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Jasper van Lieshout
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Duesseldorf, Deutschland
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Jeroen Boogaarts
- Radboud University Medical Center, Neurosurgery, Nijmegen, Niederlande
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Dagmar Verbaan
- Academic Medical Center, Neurosurgery, Amsterdam, Niederlande
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: In current clinical practice, obliteration of the ruptured intracranial aneurysm is initiated as soon as technically and logistically feasible in order to reduce the risk of rebleeding. A possible disadvantage of immediate occlusion of a ruptured aneurysm is a high rate of procedural complications. We aimed to evaluate whether timing of endovascular aneurysm closure is a risk factor for per-procedural aneurysm re-rupture and if per-procedural aneurysm re-rupture has clinical impact.
Methods: From a database of consecutive patients with aSAH who were treated at the Radboud University Medical Center in Nijmegen and the Academic Medical Center in Amsterdam, between January 2012 and January 2016, we selected those treated by endovascular embolization. We assessed predictors of procedural aneurysm re-rupture and spontaneous aneurysm rebleeding by univariate analysis. Outcome was measured after six months of follow-up with the modified Rankin Scale (mRS). Determinants for outcome were assessed by multivariate analysis.
Results: From a total of 471 patients (mean age 57; 69.4% female), we found per-procedural aneurysm re-rupture in 12 (2.5%) of 471 included patients. In seven of these, endovascular coiling had taken place within six hours after ictus. Endovascular treatment within six hours after aSAH was a predictor for per-procedural aneurysm re-rupture (OR 9.0, 95% CI 2.8-29 p<0.001). Procedural re-rupture was related to poor outcome (mRS>2; aOR 7.0, 95% CI 1.9-26; p=0.019, adjusted for age and clinical grade on admission) and increased case-fatality (aOR 7.8 95% CI 2.4 - 25; p<0.001).
Conclusion: Emergency (<6 hours) endovascular coil embolization had a nine times higher risk of per-procedural rupture than embolization after six hours. Early per-procedural aneurysm re-rupture results in a reduced chance of returning to daily life and increased case-fatality. Prevention of per-procedural rupture by defining patients at risk or technical innovations may improve outcome in patients with aSAH.
