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Neuroradiology

, Volume 54, Issue 7, pp 719–726 | Cite as

Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms

  • Young Dae Cho
  • Jong Young Lee
  • Jung Hwa Seo
  • Hyun-Seung KangEmail author
  • Jeong Eun Kim
  • O-Ki Kwon
  • Young Seob Chung
  • Moon Hee Han
Interventional Neuroradiology

Abstract

Introduction

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.

Conclusion

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.

Keywords

Aneurysm Rebleeding Coiling Embolization Ruptured aneurysm 

Notes

Conflict of interest

We declare that we have no conflict of interest.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Young Dae Cho
    • 1
  • Jong Young Lee
    • 2
  • Jung Hwa Seo
    • 2
  • Hyun-Seung Kang
    • 3
    Email author
  • Jeong Eun Kim
    • 3
  • O-Ki Kwon
    • 4
  • Young Seob Chung
    • 5
  • Moon Hee Han
    • 2
    • 3
  1. 1.Department of Radiology, Seoul National University Boramae Medical CenterSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of Radiology, Seoul National University HospitalSeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of Neurosurgery, Seoul National University HospitalSeoul National University College of MedicineSeoulSouth Korea
  4. 4.Department of Neurosurgery, Seoul National University Bundang HospitalSeoul National University College of MedicineSeoulSouth Korea
  5. 5.Department of Neurosurgery, Seoul National University Boramae Medical CenterSeoul National University College of MedicineSeoulSouth Korea

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