Aneurysmal re-rupture during selective cerebral angiography

Abstract

Two cases of aneurysmal re-rupture during intracranial angiography are presented. This event is accompanied by disastrous consequences with regard to the clinical condition of the patient, as is evident from the cases presented as well as from the literature. Acute alterations of intraluminal pressure as well as a time interval of less than 6 h seems to increase the risk of re-bleeding during angiography. The introduction of and the growing experience with CT and MR angiography may in the near future provide sufficient diagnostic information for surgical planning and thus help to overcome the risk of aneurysmal re-rupture during intra-arterial angiography.

Incidence and Risk Factors for Rebleeding during Cerebral Angiography for Ruptured Intracranial Aneurysms

“… 11 Previous studies revealed that the incidence of rebleeding during cerebral angiography occurred in 0.1-8.7% and was an independent factor for mortality. 3 , 4 , 5 , 12 In our study, overall rebleeding rate was 9.7% (184/1896), showing a lower rebleeding rate compared to previous studies, and the incidence of rebleeding during DSA was 0.6% in the ruptured aneurysm group (n=1896) and 5.9% in the rebleeding group (n=184). Multivariate analysis showed that aneurysm location ( p =0.048) and AR ( p =0.041) was an independent risk factors for rebleeding during DSA.…”

“…Extravasation of contrast medium due to rebleeding during cerebral angiography occurs in 0.1-8.7% of cases and is an independent factor for mortality. 3 , 4 , 5 Findings from previous studies show a high rate of mortality after rebleeding during cerebral angiography. 6 , 7 , 8 After 3DRA is applied to neurointerventional field, however, the incidence of rebleeding and risk factors related to rebleeding during cerebral angiography have to be re-evaluated.…”

Active rebleeding from a ruptured middle cerebral artery aneurysm during diagnostic catheter angiography

“…In the literature, the incidence was reported between 0.01-4% (9,11,15). This entity is more common among female patients which could be secondary to female predisposition for SAH (2,5,11,19). More recent publications reported rebleeding during head CT angiography as well (3,13).…”

“…Poor neurological condition at admission, aneurysm site and angiography within the first 6 hours of SAH were proposed as risk factors for rebleeding. Early angiography appears to be a prominent risk factor according to previous publications (2,10,19). Komiyama et al reviewed 202 cases from the literature including 14 cases of their own.…”

“…In literature, the majority of the rebleeding aneurysms during angiography were located at the ICA or MCA (2,6,9,11,19). The reason behind this tendency could be the higher incidence of aneurysms located at the anterior circulation.…”