Analysis of the reasons for early re-ruptures of intracranial ruptured aneurysms embolized in acute phase

Objective To evaluate the probably risk factors correlated to the early stage re-rupture of intracranial aneurysms embolized in acute phase.Methods 689 consecutive patients(24-72 years old) with 689 ruptured and 25 un-ruptured intracranial aneurysms underwent coiling within 72 hours since SAH onset.All the patients,including whose aneurysms were re-ruptured in the early stage after coiling,were collected,and the neurological signs and symptoms before and after coiling were analyzed as well as the imageological material(including CT and DSA).Data were analyzed by Logistic regression.A value of P0.05 was considered statistically significant.Results Six cases,accounting for 0.9%(6/689)of all the patients underwent coiling in the same phase,were found with re-ruptured aneurysms,among which four eases were validated by CT and one was validated by continued lumbar cistern drainage.The remained one was validated by clinical manifestation.There were four re-ruptured aneurysms located on the anterior communicating arteries and the other two in the superior segment of clinoid process.The ratios of high intracranial pressure,high Fisher grade and prolonged circulation time in the re-ruptured group were more than those in the non-re-ruptured one.Conclusions Our findings suggest that incompletely embolization of aneurysms and unreal visualization of aneurysms in acute phase were probably the main reasons for early stage re-rupture of aneurysms embolized in acute phase.Vasospasm,intracranial hypertension and hematoma of peri-aneurysms were probably the main reasons for unreal visualization of aneurysms in acute phase when angiography performed.Early re-examination by DSA and further treatment after first embolization may reduce the chance of re-rupture of intracranial aneurysms.