Endovascular Management of Ruptured Intracranial Arterial Aneurysms: Our Experience in the Last 2 Years

Objectives: Ruptured intracranial arterial aneurysms are a diagnostic and therapeutic emergency. Endovascular treatment, consisting of conventional coiling with or without balloon remodeling, is becoming the first adequate treatment done promptly to avoid a recurrent rupture and improve patient outcome with a low thromboembolic and hemorrhagic risks. The objective of our study is to assess the feasibility, safety, and efficacy of endovascular coiling in our experience in the last 2 years. Methods: We carried a 2-year retrospective study (between January 2017 and January 2019) of 98 patients who were hospitalized for a ruptured intracranial arterial aneurysm and underwent an endovascular embolization using conventional coiling. Results: The study group of the patients included 43 men (44%) and 55 women (56%) with a mean age of 59 years. Twenty-nine patients (30%) had arterial hypertension. Headaches and vomiting were the main symptoms present together in 29 patients (30%). Fisher score varied from I to IV with a predominant IV score in 44 patients (49%). As for the World Federation of Neurological Surgeons score, it varied from I to V with a predominant I score in 74 patients (74%). Primary complications seen at the time of hospitalization were observed in 20 patients (20%): 10 patients (10%) had hydrocephalus and 11 (11%) patients had a neurologic deficit. Aneurysms were diagnosed using computed tomographic angiography in 39 patients (40%). Angiographic analysis showed that aneurysms occurred mainly on A1A2 junctions with the following distribution. Three patients had concomitant arteriovenous malformations. Intracranial arterial vasospasm was observed in angiography in 26 patients (27%), explaining the use of 2–8 mg of Nimotop. Balloon remodeling technique was used in 22 patients (22%). 11 (50%) of the latter had a carotid artery aneurysm. With regard to coiling, in the 86 patients (88%) where data were available for both coiling and aneurysmal measurements, we present the distribution of number of coils according to the aneurysmal measurements Figure 2. In 10 patients (10%), a residual neck was left. On case of aneurysmal rupture during the procedure, was noted (1%) with intracranial hematoma. Only one patient (1%) had intracranial arterial microemboli during the procedure. Conclusion: Endovascular coiling of ruptured intracranial arterial aneurysms is safe and effective. It is used as a first-line treatment in emergency. Going forward, we suggest the establishment of a result predicting score in patient having endovascular treatment for ruptured aneurysms.

Publication History

Article published online:
26 April 2021