title: Factors responsible for poor outcome after intraprocedural rerupture of ruptured intracranial aneurysms: identification of risk factors, prevention and management on 18 cases.
abstract: OBJECTIVE
  The paper mainly involved the retrospective approach to risk factors of intraprocedual rerupture (IPR) and illustration of our empirical prevention and management on this event as well as its postembolization outcomes evaluation.
  
  
  METHODS
  Endovascular treatment was performed in 1308 patients with 1308 ruptured intracranial aneurysms, and IPR occurred in 18 cases. We retrospectively reviewed their clinical records and images, and analysis risk factors of IPR by using multivariate logistic regression.
  
  
  RESULTS
  The morbidity of IPR was 1.38% and mortality was 33.33%. Nine patients survived from rapid completion of coiling with immediate reversal of heparin anticoagulation with protamine sulfate, and 3 from emergent external ventricular drainage (EVD). However, 9 of them presented with different degrees of disability and 3 were fully recovered. Small aneurysms (diameter ≤ 3.0mm) (OR 284.212, 95% C.I. 17.368-4650.780, P=0.000), atherosclerosis (OR 7.866, 95% C.I. 1.113-55.570, P=0.039), Fisher Grade III (OR 82.099, 95% C.I. 1.563-431.696, P=0.029), vasospasm (grade I) (OR 32.269, 95% C.I. 2.393-435.132, P=0.009) and vasospasm (grade II) (OR 30.238, 95% C.I. 1.770-516.552, P=0.019) are risk factors of IPR. Aneurysms at proximal part of internal carotid artery (ICA), bifurcation and basilar artery (BA) stem (OR 0.003, 95% C.I. 0.000-0.101, P=0.001) and Hunt and Hess Grade II (OR 0.010, 95% C.I. 0.000-0.346, P=0.011) are identified as protective factors.
  
  
  CONCLUSIONS
  Small aneurysms, atherosclerosis, Fisher Grade of SAH and cerebral vasospasm are the predictors of IPR. Aneurysms at proximal part of ICA bifurcation and BA stem and Hunt and Hess Grade II are less associated with IPR. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation is confirmed to be the best strategy in our series.
authors.affiliation: Department of Neurosurgery, Southern Medical University, Zhujiang Hospital, 253# Industry Road, 510282 Guangzhou, Guangdong, China. zhangxin19830818@163.com
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Xiao-Ao
authors.initials: XA
authors.lastname: Long
authors.forename: Bin
authors.initials: B
authors.lastname: Luo
authors.forename: Tamrakar
authors.initials: T
authors.lastname: Karuna
authors.forename: Chuan-Zhi
authors.initials: CZ
authors.lastname: Duan
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control*; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome