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Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms

  • Interventional Neuroradiology
  • Published:
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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.

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea

    Young Dae Cho

  2. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Jong Young Lee, Jung Hwa Seo & Moon Hee Han

  3. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul, 110-744, South Korea

    Hyun-Seung Kang, Jeong Eun Kim & Moon Hee Han

  4. Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea

    O-Ki Kwon

  5. Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea

    Young Seob Chung

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  1. Young Dae Cho
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  2. Jong Young Lee
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  3. Jung Hwa Seo
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  4. Hyun-Seung Kang
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  5. Jeong Eun Kim
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  7. Young Seob Chung
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  8. Moon Hee Han
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Corresponding author

Correspondence to Hyun-Seung Kang.

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Cho, Y.D., Lee, J.Y., Seo, J.H. et al. Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms. Neuroradiology 54, 719–726 (2012). https://doi.org/10.1007/s00234-011-0950-3

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  • DOI: https://doi.org/10.1007/s00234-011-0950-3

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