Abstract W P83: The Clinical Sequelae of Intraprocedural Aneurysmal Ruptures
Introduction: Aneurysmal (SAH) continues to be a significant cause of morbidity and mortality, despite advances in neuro critical care and management of vasospasm. Endovascular techniques have evolved rapidly and are safe alternatives to surgical clipping. Nonetheless, intra procedural ruptures are a serious complication with long term consequences. Our aims were to note the vital sign changes leading up to an intraprocedural rupture and to determine clinical outcomes of patients who had experienced such an event. We investigated whether patients who received immediate balloon assistance upon rupture fared better post-procedurally.
Methods: This study utilized a single institution retrospective analysis of consecutive cases of intraprocedural aneurysmal ruptures from July of 2009 to July 2014 at the Medical University of South Carolina. Patient charts and angiographic records were reviewed. All cases were performed under general anesthesia in the neuro interventional suite with invasive blood pressure monitoring.
Results: 13 intraprocedural aneurysmal ruptures were reviewed. 8 were female and 5 were male, with ages ranging from 35 to 80 years. 8 aneurysms were unruptured at the time of the procedure, while 5 presented with SAH. 10 ruptures were treated with balloon inflation, 4 of which did not have a balloon immediately in place at the time of rupture. 4 patients had the rupture treated with balloon inflation only, 1 was treated with protamine injection, and 5 were treated with both balloon inflation and protamine. Mean heart rate was 77.6 bmp (+/- 10.9) prior to rupture and mean post rupture heart rate was 75.9 bmp (+/- 12.2), for an average change of -1.63 bpm (+/- 10.8). Average SBP prior to rupture was 106.4 mmHg (+/- 11.5), with a post rupture SBP of 119.2 mmHg (+/- 18) for an average elevation of 12.8 mmHg (+/- 11.6). Of the 5 patients whose CT scans remained unchanged from baseline, all had a balloon available for inflation, none needed a EVD, and no neurological deficits due to intraprocedural perforation were noted.
Conclusions: Our study suggests that balloon assisted embolization procedures tend to produce better clinical outcomes. Further examination of the effects of both heart rate and systolic blood pressure leading up to ruptures will be necessary.
Author Disclosures: R. Peneva: None. J. Vargas: None. A.S. Turk: Research Grant; Modest; Microvention. Speakers' Bureau; Modest; Penumbra, Stryker. Honoraria; Modest; Microvention, Coviden. M. Chaudry: Research Grant; Modest; Microvention. Speakers' Bureau; Modest; Microvention, Stryker, Penumbra. R.D. Turner: Consultant/Advisory Board; Modest; Stryker, Siemens, Pulsar, Penumbra, Microvention. A. Spiotta: Consultant/Advisory Board; Modest; Microvention, Stryker, Pulsar, Penumbra.
- © 2015 by American Heart Association, Inc.