Document Detail


Acute serious rebleeding after angiographically successful coil embolization of ruptured cerebral aneurysms.
MedLine Citation:
PMID:  20099070     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The present study investigated the incidence of acute rebleeding after successful coil embolization of a ruptured cerebral aneurysm, including clinical outcomes, and possible mechanisms of the events other than coil compaction and/or incomplete embolization.
MATERIALS AND METHODS: This study included 591 consecutive patients who presented with aneurysmal subarachnoid hemorrhage, were treated with coil embolization, and whose post-procedural angiography revealed successful embolization. Data were collected retrospectively from six patients who showed acute rebleeding despite that angiographically successful coil embolization was achieved. All clinical, radiological data and intraoperative videos were reviewed to identify causative factors which could have contributed to the occurrence of rebleeding.
RESULTS: Incidence of acute rebleeding after successful coil embolization of ruptured cerebral aneurysm was 1.0% (6/591). In all of these six patients, complete angiographic occlusion was achieved except in one case where a small residual neck was intentionally left to avoid compromise of the parent artery. Four of the six patients showed poor clinical courses, either died or recovered with severe disability. Whenever possible, we performed an immediate craniotomy for exploration and additional clipping. Based on intraoperative findings, we hypothesized that uneven distribution of the coil masses and spontaneous resolution of thrombus among the strands of coil (inter-coil-loop thrombolysis) could be possible mechanisms of rebleeding.
CONCLUSION: Acute rebleeding is extremely rare, but is possible as a complication of coil embolization of a ruptured cerebral aneurysm even when a case is angiographically successful. The higher degree of morbidity and mortality is a major concern. Therefore, further investigation to discover risk factors and causative mechanisms for such a complication is sorely needed.
Authors:
Dong-Hun Kang; Yong-Sun Kim; Seung-Kug Baik; Seong-Hyun Park; Jaechan Park; In-Suk Hamm
Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-01-23
Journal Detail:
Title:  Acta neurochirurgica     Volume:  152     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-19     Completed Date:  2010-07-19     Revised Date:  2011-02-18    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  771-81     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Daegu-Gyeongbuk Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Causality
Embolization, Therapeutic / adverse effects*,  instrumentation,  methods
Female
Humans
Intracranial Aneurysm / pathology,  radiography,  therapy*
Male
Middle Aged
Neurosurgical Procedures / methods
Postoperative Hemorrhage / etiology*,  physiopathology*,  radiography
Prostheses and Implants / adverse effects
Prosthesis Failure
Prosthesis Implantation / adverse effects,  methods
Recurrence
Reoperation
Retrospective Studies
Risk Assessment
Subarachnoid Hemorrhage / physiopathology*,  radiography,  therapy*
Treatment Outcome
Vascular Surgical Procedures / methods
Comments/Corrections
Comment In:
Acta Neurochir (Wien). 2011 Feb;153(2):343-4; author reply 345   [PMID:  21080008 ]

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