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Acta Neurochirurgica

Published in:

01-05-2010 | Clinical Article

Acute serious rebleeding after angiographically successful coil embolization of ruptured cerebral aneurysms

Authors: Dong-Hun Kang, Yong-Sun Kim, Seung-Kug Baik, Seong-Hyun Park, Jaechan Park, In-Suk Hamm

Published in: Acta Neurochirurgica | Issue 5/2010

Abstract

Purpose

The present study investigated the incidence of acute rebleeding after successful coil embolization of a ruptured cerebral aneurysm, including clinical outcomes, and possible mechanisms of the events other than coil compaction and/or incomplete embolization.

Materials and methods

This study included 591 consecutive patients who presented with aneurysmal subarachnoid hemorrhage, were treated with coil embolization, and whose post-procedural angiography revealed successful embolization. Data were collected retrospectively from six patients who showed acute rebleeding despite that angiographically successful coil embolization was achieved. All clinical, radiological data and intraoperative videos were reviewed to identify causative factors which could have contributed to the occurrence of rebleeding.

Results

Incidence of acute rebleeding after successful coil embolization of ruptured cerebral aneurysm was 1.0% (6/591). In all of these six patients, complete angiographic occlusion was achieved except in one case where a small residual neck was intentionally left to avoid compromise of the parent artery. Four of the six patients showed poor clinical courses, either died or recovered with severe disability. Whenever possible, we performed an immediate craniotomy for exploration and additional clipping. Based on intraoperative findings, we hypothesized that uneven distribution of the coil masses and spontaneous resolution of thrombus among the strands of coil (inter-coil-loop thrombolysis) could be possible mechanisms of rebleeding.

Conclusion

Acute rebleeding is extremely rare, but is possible as a complication of coil embolization of a ruptured cerebral aneurysm even when a case is angiographically successful. The higher degree of morbidity and mortality is a major concern. Therefore, further investigation to discover risk factors and causative mechanisms for such a complication is sorely needed.

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Title: Acute serious rebleeding after angiographically successful coil embolization of ruptured cerebral aneurysms
Authors: Dong-Hun Kang
Yong-Sun Kim
Seung-Kug Baik
Seong-Hyun Park
Jaechan Park
In-Suk Hamm
Publication date: 01-05-2010
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 5/2010
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-009-0593-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute serious rebleeding after angiographically successful coil embolization of ruptured cerebral aneurysms

Abstract

Purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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