The following is a summary of “Risk factors and management of intraprocedural rupture during coil embolization of unruptured intracranial aneurysms: role of balloon guiding catheter,” published in the January 2024 issue of Neurology by Aoki et al.
Despite the devastating consequences of intraprocedural rupture (IPR) during unruptured intracranial aneurysms (UIAs) coiling, strategies for minimizing subsequent neurological decline remain unexplored.
Researchers started a retrospective study to assess the impact of balloon guiding catheters (BGCs) on rapid hemostasis in IPR, analyzing risk factors and management strategies.
They conducted a retrospective analysis of UIA cases undergoing coil embolization at three institutions (2003 to 2021), emphasizing preoperative radiological data, operative specifics, and outcomes.
The results showed 2,172 aneurysms with 2,026 patients treated. Among them, 19 aneurysms in 19 patients (0.8%) experienced rupture during the procedure. Multivariate analysis demonstrated significant associations with IPR for aneurysms with a bleb (OR: 3.03, 95% CI: 1.21 to 7.57, P=0.017), small neck size (OR: 0.56, 95% CI: 0.37 to 0.85, P=0.007), and aneurysms in the posterior communicating artery (PcomA) (OR: 4.92, 95% CI: 1.19 to 20.18, P=0.027), as well as the anterior communicating artery (AcomA) (OR: 12.08, 95% CI: 2.99 to 48.79, P<0.001) compared to the internal carotid artery without PcomA. The incidence of IPR was similar between the non-BGC and BGC groups (0.9% vs. 0.8%, P=0.822). However, using BGC was linked to lower morbidity and mortality rates after IPR (0% vs. 44%, P=0.033).
They concluded that few IPRs occurred, with blebs, small necks, and PcomA/AcomA posing risks, while BGCs may improve outcomes.
Source: frontiersin.org/articles/10.3389/fneur.2024.1343137/full