title: Rupture during treatment of recently ruptured aneurysms with Guglielmi electrodetachable coils.
abstract: OBJECTIVE
  We describe four cases of aneurysmal rupture during embolization with Guglielmi electrodetachable coils (GDCs) in an attempt to identify those aneurysms whose rupture during embolization represents a life-threatening risk; our emphasis is on emergency management, in particular, ventriculostomy.
  
  
  METHODS
  Medical records were reviewed retrospectively for 91 aneurysms treated with GDCs 0 to 21 days after subarachnoid hemorrhage. Rupture was ascertained by the presence of extravascular effusion of contrast medium.
  
  
  RESULTS
  Of the perforated aneurysms, two involved the anterior communicating artery, one the posterior inferior communicating artery, and one the basilar artery. Only two patients, whose aneurysms were located in the posterior fossa, had major complications (arterial hyperpressure, mydriasis, angiographically documented circulatory arrest or slowing). One of these patients died and the other improved after emergency ventriculostomy.
  
  
  CONCLUSIONS
  Aneurysmal perforation during embolization may be accompanied by severe intracranial hypertension, which causes either a decrease or arrest of cerebral perfusion, the duration of which determines clinical outcome. Emergency ventriculostomy (which should be performed in the angiographic suite) is an effective means to reduce intracranial pressure. Recognition of aneurysms associated with a high risk of mortality by rupture in the course of embolization (recently ruptured small aneurysms, posterior fossa aneurysms, associated ventricular dilatation, massive cisternal hemorrhage) and use of proper logistics should ensure the effective management of this devastating complication.
authors.affiliation: Service de Neuroradiologie, Département d'Anesthésie Réanimation, Hôpital Henri Mondor, Créteil, France.
authors.forename: F
authors.initials: F
authors.lastname: Ricolfi
authors.forename: C
authors.initials: C
authors.lastname: Le Guerinel
authors.forename: J
authors.initials: J
authors.lastname: Blustajn
authors.forename: C
authors.initials: C
authors.lastname: Combes
authors.forename: P
authors.initials: P
authors.lastname: Brugieres
authors.forename: E
authors.initials: E
authors.lastname: Melon
authors.forename: A
authors.initials: A
authors.lastname: Gaston
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D004632:Emergency Medical Services; D004867:Equipment Design; D004864:Equipment and Supplies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014696:Ventriculostomy