Neurointervention.  2011 Feb;6(1):17-22. 10.5469/neuroint.2011.6.1.17.

Vascular Perforation During Coil Embolization of an Intracranial Aneurysm: the Incidence, Mechanism, and Clinical Outcome

• Ryu CW
• Lee CY
• Koh JS
• Choi SK
• Kim EJ

• KMID: 1783977
• DOI: http://doi.org/10.5469/neuroint.2011.6.1.17

Abstract

PURPOSE
The occurrence of a vascular perforation during an endovascular procedure is an unexpected and feared complication which can be fatal. However, the incidence, risk or the mechanism of vascular perforation which can occur in the endovascular management of aneurysms remains unclear. The purpose of the present study was to evaluate the incidence of vascular perforation during endovascular coil embolization of a cerebral aneurysm, and to reveal characteristics and clinical outcomes.
MATERIALS AND METHODS
We reviewed the endovascular coil embolization procedures performed for the treatment of 459 aneurysms. Incidence and clinical, radiological and technical data of patients concerning the vascular perforation were reviewed from medical records and radiological findings.
RESULTS
The incidence of procedure-related vascular perforation in our patient group was 0.87% (4/459). For all four occurrences, the cause of vascular perforation involved the guidewire or microcatheter. Clinical outcome was poor in 2 cases and favorable in 2 cases.
CONCLUSION
Although rare, the occurrence of vascular perforation during coil embolization for treatment of an aneurysm may be fatal. Therefore, careful management of the guidewire is suggested for the prevention of vascular rupture during an endovascular procedure.

Keyword

Vascular perforation; Intracranial aneurysm; Coil embolization

MeSH Terms

Aneurysm
Endovascular Procedures
Humans
Incidence
Intracranial Aneurysm
Medical Records
Rupture

Figure

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  Fig. 1 A 44-year-old man with diffuse subarachnoid hemorrhage and rupture of anterior communicating artery aneurysm (Case No. 4). After coil embolization of aneurysm, left carotid angiogram reveals coil mesh within aneurysm (arrow) and embolic occlusion of parietal branch of left middle cerebral artery (arrowhead).

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  Fig. 2 A 48-year-old man presents with sudden onset of severe headache and drowsy mentality (Case No.1).A. Right carotid angiogram reveals a multilobulated ventral paraclinoid aneurysm.B. The guidewire is within the distal parietal branch of right middle cerebral artery. This stiff guidewire has been used to support the navigation of a balloon-expandable sent (arrows) toward a wide-neck aneurysm (At that time, the self-expandable stent was not launched in Korea).C. At the end of the procedure, the final angiogram shows successful occlusion of the aneurysm without coil protrusion into the parent artery. Any extravasation of contrast was not identified on working angle of the right carotid angiogram.D. Immediate post-procedural CT scan shows intracerebral hemorrhage in the right temporal lobe.

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