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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:506-514, March 2005
© 2005 American Society of Neuroradiology

INTERVENTIONAL

Periprocedural Morbidity and Mortality Associated with Endovascular Treatment of Intracranial Aneurysms

Hae-Kwan Park^a, Michael Horowitz^b,c, Charles Jungreis^b,c, Julie Genevro^e, Christopher Koebbe^b, Elad Levy^b and Amin Kassam^d

^a Department of Neurosurgery, St Mary’s Hospital, Seoul, South Korea
^b Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
^c Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
^d Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
^e University of Pittsburgh Medical Center, Pittsburgh, PA

Address reprint requests to Michael Horowitz, MD, Department of Neurosurgery, Presbyterian University Hospital, Suite B400, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA

BACKGROUND AND PURPOSE: Despite experience and technological improvements, endovascular treatment of intracranial aneurysms still has inherent risks. We evaluated cerebral complications associated with this treatment.

METHODS: From October 1998 to October 2002, 180 consecutive patients underwent 131 procedures for 118 ruptured aneurysms and 79 procedures for 72 unruptured aneurysms. We retrospectively reviewed their records and images to evaluate their morbidity and mortality.

RESULTS: Thirty-seven (17.6%) procedure-related complications occurred: 27 and six with initial embolization of ruptured and unruptured aneurysms, respectively, and four with re-treatment. Complications included 22 cerebral thromboembolisms, nine intraprocedural aneurysm perforations, two coil migrations, two parent vessel injuries, one postprocedural aneurysm rupture, and one cranial nerve palsy. Fourteen complications had no neurologic consequence. Three caused transient neurologic morbidity; 10, persistent neurologic morbidity; and 10, death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 4.8% and 4.8%; ruptured aneurysms, 5.9% and 7.6%; unruptured aneurysms, 1.4% and 1.4%; and re-treated aneurysms, 10% and 0%. Combined procedure-related morbidity and mortality rates for ruptured, unruptured, and re-treated aneurysms were 13.5%, 2.8%, and 10%, respectively. Nonprocedural complications attributable to subarachnoid hemorrhage in 118 patients with ruptured aneurysm were early rebleeding before coil placement (0.9%), symptomatic vasospasm (5.9%), and shunt-dependent hydrocephalus (5.9%); mortality from complications of subarachnoid hemorrhage itself was 11.9%.

CONCLUSION: Procedural morbidity and mortality rates were highest in ruptured aneurysms and lowest in unruptured aneurysms. Morbidity rates were highest in re-treated aneurysms and lowest in unruptured aneurysms. No procedural mortality occurred with re-treated aneurysms. The main cause of morbidity and mortality was thromboembolism.

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