Hemorrhagic Risk of Unsecured, Unruptured Aneurysms during Hypervolemic Hypertensive Therapy in Patient with Multiple Intracranial Aneurysms

Kim, Hyung Suk; Park, Cheol Wan; Chun, Young Ill; Kim, Woo Kyung; Lee, Sang Gu; You, Chan Jong; Park, Chan Woo

Abstract

BACKGROUND: The purpose of this study is to assess the risk of hemorrhage from coexisting unsecured, unruptured aneurysms during hypervolemic hypertensive therapy after treatment for ruptured aneurysms in patients with multiple intracranial aneurysms.
METHODS
From 1995 to 2004, the authors treated 1052 patients of ruptured and unruptured aneurysms, in which 201 patients had multiple aneurysms. Of the 201 patients, 45 patients had unsecured, unruptured aneurysms after the initial treatment of ruptured aneurysms. We performed retrospective analysis for these 45 patients' data including the characteristics of unsecured, unruptured aneurysms at risk, hemodynamic parameters and duration of hypervolemic hypertensive therapy.
RESULTS
The total number of aneurysms for the 45 patients was 103, where 53 aneurysms were secured at the acute period of post-subarachnoid hemorrhage. Twenty nine out of 45 patients with unsecured, unruptured aneurysms after treatment of ruptured aneurysms had been managed with hypervolemic hypertensive therapy for symptomatic cerebral vasospasm. These 29 patients harbored 30 aneurysms. In 29 patients with hypervolemic hypertensive therapy, the mean systolic blood pressure was 181.4+/-20.7 mm Hg, the mean central venous pressure 12.5+/-2.2 mm Hg, and the mean duration of hypervolemic hypertensive therapy was 10.2+/-5.1 days. There was no hemorrhage from the 50 unsecured, unruptured aneurysms in all 45 patients with or without hypervolemic hypertensive therapy.
CONCLUSION
It is presumed that the advantage of hypervolemic hypertensive therapy in the patients with symptomatic vasospasm after surgery of ruptured aneurysms endorses its use, even in the presence of unsecured, unruptured aneurysms in patients with multiple aneurysms.