Procedural complication rate of coiling of ruptured aneurysms

This scan compares the brain pre-embolization (top half) and post-embolization (bottom half). Zoom in close for a clear view and details.

Before we continue talking about the recovery process, which is a life-long journey, let’s talk a little bit more about complications that may arise following the treatment of a ruptured brain aneurysm. While we know that out of the 2 major treatment options available throughout the world: endovascular coiling and the clipping surgery, the coiling procedure is the least invasive and most successful. The decision on which option to take lies entirely on your team of healthcare providers. I had the coiling procedure done and so far, so good.

I found a very interesting article from the American Journal of Neuroradiology (AJNR) about a study they carried out from 1985 to 2005 studying 681 consecutive patients with ruptured intracranial aneurysms who were treated with detachable coils. Procedural complications (aneurysm rupture or thromboembolic) of coiling leading to death or neurologic disability at the time of hospital discharge were recorded. For patients with procedural complications, odds ratios with corresponding 95% confidence intervals were calculated for the following patient and aneurysm characteristics: patient age and sex, use of a supporting balloon, aneurysm location, timing of treatment, clinical condition at the time of treatment, and aneurysm size.

Conclusion….

Procedural complication rate of coiling of ruptured aneurysms leading to disability or death was 5.9%. In the series, the use of a temporary supporting balloon in the treatment of wide-necked aneurysms was the only risk factor for the occurrence of complications.

NOTE……

Endovascular coiling of ruptured intracranial aneurysms has become an accepted treatment with good clinical results and adequate protection against rebleeding.

 Adverse outcome after aneurysmal subarachnoid hemorrhage may be the result of the initial impact of the hemorrhage, the occurrence of early rebleeding after treatment, and delayed events such as vasospasm and hydrocephalus.

Moreover, complications during the endovascular treatment itself can result in poor patient outcome.

Complications of endovascular coiling consist of procedural perforation by the microcatheter, microguidewire, or coil and thromboembolic complications.

Thromboembolic complications may be caused by clotting inside the guiding catheter, clot formation on the coil mesh, or clotting in parent vessels caused by induced vasospasm or malpositioned coils.

In the study, they reported the incidence of procedural complications of coiling of ruptured intracranial aneurysms leading to permanent disability or death in a consecutive series of 681 patients.

Result……

Procedural complications occurred in 40 of 681 patients, leading to death in 18 and to disability in 22 patients. There were 8 procedural ruptures and 32 thromboembolic complications. Five of 8 procedural ruptures and 13 of 32 thromboembolic complications led to mortality. Of 22 patients with procedural morbidity, 10 had a nondisabling neurologic deficit and were independent and 12 were dependent at 6 weeks after coiling. There were no patients in vegetative state. Overall procedural complications leading to death or dependency were 30 of 681.

Reference: http://www.ajnr.org/content/ajnr/27/7/1498.full.pdf

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