Rerupture of intracranial aneurysms during angiography

Aoyagi, Noboru; Hayakawa, Isao

doi:10.1007/bf01407340

Cited by 23 publications

(33 citation statements)

References 34 publications

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“…Extravasation during DSA has been reported previously [7,12,13,14] and it has been concluded that re-bleeding most often occurs when angiography is done within several hours of [7,15,16]. Extravasation may be caused by the invasiveness of the angiographic procedure itself or may arise from intermittent re-bleeding after initial rupture.…”

Section: Discussionmentioning

confidence: 87%

Extravasation on three-dimensional CT angiography in patients with acute subarachnoid hemorrhage and ruptured aneurysm

Nakatsuka¹,

Mizuno²,

Uchida³

2002

Neuroradiology

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Three-dimensional computed tomographic angiography (CTA) is a noninvasive technique for detecting lesions after acute subarachnoid hemorrhage. We encountered extravasation on CTA, a finding that has not been reported previously. Three patients with saccular aneurysms showed extravasation on CTA performed within 3 h of the onset of hemorrhage, and all three patients died within 2 weeks. At autopsy, the site of rupture of the aneurysm was confirmed in all three cases. There were two patterns of extravasation shown by CTA, which seemed to depend on the direction of rupture. Extravasation on CTA might represent the natural progression of ruptured aneurysm and may indicate a poor prognosis.

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Section: Discussionmentioning

confidence: 87%

Extravasation on three-dimensional CT angiography in patients with acute subarachnoid hemorrhage and ruptured aneurysm

Nakatsuka¹,

Mizuno²,

Uchida³

2002

Neuroradiology

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“…The fibrin net [2,18], covering the rupture on the dome of aneurysm is so friable in the early phase of clotting that it cannot tolerate even a slight difference between the internal and external pressure of the aneurysm. Conventional cerebral angiography using about 10 ml of contrast medium increases the intraluminal dynamic pressure [5] and may cause re-rupture of the ruptured wall of the aneurysm when it is performed within the first 3 hours after the initial bleed [4]. Outflow of the cerebrospinal fluid produces a transient but rapid decrease of external pressure around the dome of the aneurysm.…”

Section: Patients With Early Re-ruptured Lntracranial Aneurysmsmentioning

confidence: 99%

Study on early re-rupture of intracranial aneurysms

Aoyagi

Hayakawa

1996

Acta neurochir

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The prognosis of patients with early re-ruptured intracranial aneurysms is discouraging. We compared the data on patients suffering re-rupture before the onset of late vasospasm (Early-Re) with those suffering rebleeding thereafter (Late-Re). The operability in the Early-Re group was lower (p < 0.05) and the outcome less satisfactory than that of Late-Re group. Of the Early-Re patients, 83% had a re-rupture within 24 hours of the initial subarachnoid haemorrhage; moreover 46% of these experienced rebleeding within three hours of the initial bleeding. Cases in the Early-Re group tended to belong to Hunt-Hess grade III or IV on admission, of wide spread subarachnoid haemorrhage on CT and of "bump" type aneurysms on angiograms. Based on our experience we propose that early re-rupture may be attributable to the following factors: a gradual and progressive thinning of the wall of bump type aneurysms results in such a large laceration through the fundus of the aneurysm. Re-rupture may occur within a short period after the first rupture because the fibrin net covering the wide laceration cannot tolerate the slight increase in internal pressure within the aneurysmal dome. Therefore, in the patients of Hunt-Hess grade III or IV, conventional angiography, tight holding during CT examination and lumbar puncture, should be avoided during the first three hours after the first bleed. Although early direct operations on patients with high Hunt-Hess grades tend to produce an unsatisfactory outcome, we cannot help these patients with Early-Re without surgical treatment. Not only early direct operation but also first conservative treatment to control systolic blood pressure are very important in patients with Early-Re.

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“…18) Moreover, DSA within 6 hours after SAH is significantly associated with a high incidence of re-bleeding. 4,18,19) The risk of rebleeding increased from 2% to 5% when conventional DSA was performed, and several other reports found DSA increased the risk of re-bleeding. 4,18,21,28) Unfortunately, when re-bleeding occurred during DSA, the outcome worsened.…”

Section: Discussionmentioning

confidence: 98%

“…4,18,19) The risk of rebleeding increased from 2% to 5% when conventional DSA was performed, and several other reports found DSA increased the risk of re-bleeding. 4,18,21,28) Unfortunately, when re-bleeding occurred during DSA, the outcome worsened. 8,13,21,28,35) Therefore, performing clipping surgery as early as possible without angiography is preferable.…”

Section: Discussionmentioning

confidence: 98%

Benefits of Clipping Surgery Based on Three-Dimensional Computed Tomography Angiography

Nagai

Watanabe

2010

Neurol. Med. Chir.(Tokyo)

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The recent development of three-dimensional computed tomography (3D-CT) angiography with multi detector row CT (MDCT) improves cerebral artery imaging due to faster scanning at thinner collimation over a large scanning volume. Aneurysm clipping was performed using only 3D-CT angiography created by MDCT with 16 detector arrays (16-MDCT angiography), in place of digital subtraction angiography (DSA) to evaluate the suitability of 16-MDCT angiography for preoperative examination before aneurysm clipping, and identify the essential points when making 3D images. Thirty-two patients with subarachnoid hemorrhage (SAH) identified by initial CT or with non-ruptured aneurysm were entered in this study. Twenty-six SAH patients underwent 3D-CT angiography, and aneurysms were treated by clipping (n ＝ 25) or coil embolization (n ＝ 4). One patient with no aneurysm depicted by 3D-CT angiography underwent conventional DSA twice subsequently. The sensitivity of 16-MDCT angiography to depict aneurysms in patients with SAH, and time between admission and entering the operating room were evaluated, and compared with those under the former protocol using DSA. The sensitivity of 16-MDCT angiography for aneurysm detection was 100%. Shapes of all aneurysms depicted by 3D-CT angiography were validated intra-operatively. The mean operation waiting time was 2.8 hours, with the shortest time being 1.5 hours. Re-bleeding occurred in one of the 20 patients. We conclude that shorter preoperative waiting time decreased the incidence of premature re-bleeding, resulting in better outcomes. We highly recommend that the surgeon sets the threshold value, and rotates the 3D image to establish better surgical orientation.

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Rerupture of intracranial aneurysms during angiography

Cited by 23 publications

References 34 publications

Extravasation on three-dimensional CT angiography in patients with acute subarachnoid hemorrhage and ruptured aneurysm

Extravasation on three-dimensional CT angiography in patients with acute subarachnoid hemorrhage and ruptured aneurysm

Study on early re-rupture of intracranial aneurysms

Benefits of Clipping Surgery Based on Three-Dimensional Computed Tomography Angiography

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