J Cerebrovasc Endovasc Neurosurg.  2023 Dec;25(4):420-428. 10.7461/jcen.2023.E2023.07.004.

Correlation between contrast leakage period of procedural rupture and clinical outcomes in endovascular coiling for cerebral aneurysms

• Kim ST
• Jin SC
• Jeong HW
• Baek JW
• Jeong YG

• KMID: 2549447
• DOI: http://doi.org/10.7461/jcen.2023.E2023.07.004

Abstract

Objective
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.
Methods
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.
Results
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).
Conclusions
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.

Keyword

Intracranial aneurysm; Intraoperative complication; Endovascular procedures; Rupture

Figure

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  Fig. 1. Intraprocedural rupture of a residual ruptured posterior communicating artery aneurysm after clipping. (A) A working view of the patient is shown. (B) Coil loop extrusion occurring during coil packing under stent jailing and (C) contrast leakage (white arrow) revealing intraprocedural rupture are shown. In (D), a final image after coiling reveals good packing of the aneurysm.

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  Fig. 2. In a left unruptured paraclinoid aneurysm, treatment via stent-assisted coiling was planned. (A) White arrows indicate contrast leakage after intraprocedural rupture (IPR) at coil embolization. IPR developing in the stent jailing step and contrast leakage are shown on conventional angiography, with (B) black arrows indicate significant decreases in somatosensory-evoked potential (SSEP) amplitude in both legs first detected after IPR. (C) Black arrowheads indicate significant decreases in motor-evoked potential (MEP) amplitude in both legs are shown. After control of IPR, recovery of decreased MEP amplitude preceding recovery of decreased SSEP amplitude is shown in (D) and (E), respectively.

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