title: Intraprocedural aneurysmal rupture during coil embolization of brain aneurysms: role of balloon-assisted coiling.
abstract: OBJECTIVE
  Intraprocedural aneurysmal rupture is a feared complication of coil embolization of intracranial aneurysms and is associated with high rates of morbidity and mortality. We report the incidence, endovascular management, and clinical outcome of patients with IAR, with emphasis on the role of the balloon-assisted technique.
  
  
  METHODS
  We conducted a retrospective analysis of all intracranial aneurysms treated by coil embolization between September 2001 and June 2011. All patients with IAR were studied. Comparison of immediate clinical outcomes was performed by using univariate analysis (Fisher exact test).
  
  
  RESULTS
  Of 652 intracranial aneurysms treated with coil embolization, an IAR occurred in 22 (3.4%). Rupture occurred during placement of coils in 18 cases, microcatheters in 2 cases, and a guidewire in 1 case, and during induction of anesthesia in 1 case. Before treatment, 15 of 22 (68%) patients were in good clinical condition (WFNS grade I). There were fewer patients with worsening of the WFNS grade following an IAR when the balloon-assisted technique was used (7.7%) compared with when it was not (55.5%) (P = .023). Death occurred in 2 (9.1%) patients.
  
  
  CONCLUSIONS
  IAR is a potentially serious complication of coil embolization. If IAR occurs, balloon-assistance is helpful in obtaining rapid hemostasis resulting in better short-term outcomes.
authors.affiliation: Division of Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10065, USA. als2052@med.cornell.edu
authors.forename: A
authors.initials: A
authors.lastname: Santillan
authors.forename: Y P
authors.initials: YP
authors.lastname: Gobin
authors.forename: E D
authors.initials: ED
authors.lastname: Greenberg
authors.forename: L Z
authors.initials: LZ
authors.lastname: Leng
authors.forename: H A
authors.initials: HA
authors.lastname: Riina
authors.forename: P E
authors.initials: PE
authors.lastname: Stieg
authors.forename: A
authors.initials: A
authors.lastname: Patsalides
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000453:epidemiology*; D021721:Balloon Occlusion / Q000706:statistics & numerical data*; D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment