Severe intracranial bleedings during endovascular procedures: outcome of surgically treated patients.
OBJECTIVE
Severe intracranial bleedings (SIBs) during endovascular procedures (EPs) are accompanied by acute intracranial hypertension and brain herniation signs. The purpose of this study was to determine the effectiveness of urgent surgical management and its related patient outcome in cases with such a fatal complication.


METHODS
Medical records were reviewed retrospectively for the last 750 patients treated in our department in the past 12 years with acute non-traumatic intracranial bleeding, who underwent a diagnostic or therapeutic EP. Patients with a severe intra-procedural bleeding episode undergoing urgent surgical management (within 30 minutes after bleeding) were analysed.


RESULTS
Fourteen of 750 patients with ruptured vascular malformations presented a new SIB during EP. In nine patients, this occurred during initial angiography, two during aneurysm coiling, two during balloon angioplasty and one during arteriovenous malformation (AVM) embolization. The neurological condition 6 months later was good (independents patients) in seven cases with only a mild disability in two of them. Two patients showed a severe disability. Four patients died without recovering their consciousness. One patient presented a satisfactorily course but died weeks later owing to a pulmonary embolism.


CONCLUSIONS
Despite the fatal spontaneous prognosis of severe intracranial bleeding occurring during endovascular diagnostic or therapeutic procedures, a favorable outcome can be expected if an appropriated treatment was set within 30 minutes of the bleeding.
Carvi y Nievas
Mario
M
Department of Neurosurgery, Städtische Kliniken, Frankfurt am Main-Höchst, Germany. MCNievas@t-online.de
Haas
Eberhard
E
Höllerhage
Hans-Georg
HG
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001165:Arteriovenous Malformations / Q000601:surgery; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D002533:Cerebral Angiography / Q000009:adverse effects; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000601:surgery*; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007431:Intraoperative Complications / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*