title: Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms.
abstract: BACKGROUND
  The authors present a series of patients in whom early rebleeding occurred after coiling for ruptured aneurysms. We investigated the incidence and possible mechanisms of early rebleeding.
  
  
  METHODS
  This study consisted of 1,167 consecutive patients who underwent coiling for a ruptured saccular aneurysm. Clinical and radiological data were collected retrospectively from three institutions. Early rebleeding was defined as occurrence of further bleeding within 30 days after coiling with worsening of the patient's condition. We divided early rebleeding into hyperacute, subacute, and delay groups depending on the timing of rebleeding after coil embolization.
  
  
  RESULTS
  Incidence of early rebleeding after coiling of a ruptured saccular aneurysm was 1.1% (13 of 1,167), and mortality was 31% (4 of 13) in our series. Out of ten patients in hyperacute group, three (30%) had incomplete occlusion result and six patients (60%) underwent intra-arterial (IA) infusion of abciximab or tirofiban during the procedures. Seven patients (70%) had an intracerebral hemorrhage (ICH) on initial computed tomography. Four patients died, another four sustained severe disabilities, and the others had good recovery. All three patients in subacute and delay group showed recanalization on post-rebleeding angiography and made an excellent recovery.
  
  
  CONCLUSIONS
  Early rebleeding was associated with high mortality and morbidity. IA abciximab infusion or thrombolytic interventions during the procedure, maintenance of anticoagulation after the procedure, incomplete treatment of the aneurysms, and presence of ICH seemed to be related to hyperacute early rebleeding after coiling. Increased aneurysmal size and coil compaction could induce subacute and delayed early rebleeding.
authors.affiliation: Department of Radiology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Cho
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Seo
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.forename: Young Seob
authors.initials: YS
authors.lastname: Chung
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome