Early rebleeding after coiling of ruptured intracranial aneurysms.
BACKGROUND
Early rebleeding after coiling of a ruptured intracranial aneurysm (IA) may cause disability or death. The incidence and predictors of early rebleeding have previously been sparsely investigated.


OBJECTIVE
To assess the incidence and risk factors of early rebleeding after coiling of a ruptured IA and to analyze the outcome of the patients suffering early rehemorrhage.


METHODS
The data of 194 consecutive acutely (within 3 days) coiled patients with saccular ruptured IAs were analyzed. Age, gender, hypertension, aneurysm multiplicity, Hunt et Hess (HH) grade, intracerebral hematoma (ICH), intraventricular hematoma (IVH), external ventricular drainage (EVD), aneurysm location and size, and the grade of the initial aneurysm occlusion were tested to find the risk factors for early rebleeding. The outcome of the patients suffering rehemorrhage was verified.


RESULTS
Early rebleeding after coiling occurred in 7 patients out of 194 (3.6%). The presence of an ICH at admission and HH grade 3–5 before coiling were significant risk factors for rebleeding. An early rehemorrhage appeared as an enlargement of the initial ICH in all of these patients. Six of seven patients had good outcome (Glasgow Outcome Scale, GOS, 3–5). Logistic regression analysis did not find any other statistically significant risk factors.


CONCLUSIONS
The incidence of early rebleeding after acutely coiled ruptured IA was 3.6%. Risk factors for post-procedural rehemorrhage were the presence of ICH on the initial CT and HH grade 3–5 before coiling. Early rebleeding appeared exclusively as an enlargement of the initial ICH and not an increased amount of blood in the subarachnoid space.
Jartti
Pekka
P
Department of Diagnostic and Interventional Radiology, Oulu University Hospital, OYS, Finland. pekka.jartti@ppshp.fi
Isokangas
Juha-Matti
JM
Karttunen
Ari
A
Jartti
Airi
A
Haapea
Marianne
M
Koskelainen
Tatu
T
Tervonen
Osmo
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome