title: Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study.
abstract: OBJECTIVE
  Intraprocedural rupture (IPR) is a well known complication of intracranial aneurysm treatment. Risks and predictors of IPR and its impact on outcome have not been clearly established.
  
  
  METHODS
  Potential predictors of IPR were evaluated in patients treated in the Cerebral Aneurysm Rerupture After Treatment (CARAT) study using multivariate logistic regression with stepwise elimination stratified by treatment modality. Periprocedural death or disability was defined as death or a change of >or=2 points on the Modified Rankin Scale at discharge compared to before treatment.
  
  
  RESULTS
  IPR occurred in 14.6% of 1010 patients (299 coiled, 711 clipped): 19% with clipping and 5% with coiling (P<0.001). Among those clipped, 31% with IPR had periprocedural death or disability compared to 18% without IPR (P=0.001); among those coiled, 63% with IPR had periprocedural death or disability compared to 15% without IPR (P<0.001). Overall, coronary artery disease and initial lower Hunt and Hess Grade were independent predictors of IPR. For those undergoing coiling, independent predictors of IPR were Asian race, black race, COPD, and lower initial Hunt and Hess Grade. Among those undergoing clipping, hyperlipidemia and lower initial Hunt and Hess Grade were both independent predictors of IPR.
  
  
  CONCLUSIONS
  IPR was common in patients undergoing treatment of ruptured aneurysms, particularly with surgical clipping. The frequency of IPR with new disability was similar in the surgical and endovascular treatment groups. Coronary artery disease, hyperlipidemia, race, COPD, and lower Hunt and Hess Grade were associated with greater risk of IPR, which may reflect differences in vessel fragility but requires further confirmation.
authors.affiliation: Department of Neurology, University of California San Francisco, San Francisco, CA 94143-0114, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
authors.forename: Randall T
authors.initials: RT
authors.lastname: Higashida
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
authors.forename: Gary
authors.initials: G
authors.lastname: Duckwiler
authors.forename: Steven
authors.initials: S
authors.lastname: Giannotta
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D020520:Brain Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010043:Outcome and Process Assessment, Health Care; D044469:Racial Groups; D011859:Radiography; D012307:Risk Factors; D012421:Rupture; D013525:Surgical Instruments / Q000009:adverse effects*; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects*