Article Figures & Data
Figures
- Fig 1.
Serial angiograms of patient 5, a 53-year-old man in poor clinical condition after SAH.
A, Diagnostic angiogram 1 day after SAH, showing a very small aneurysm on the anterior communicating artery with a filling defect (thrombus) in the fundus. The aneurysm was judged to be too small for coil treatment.
B, Angiogram 11 days later, showing disappearance of the fundal thrombus and enlargement of the aneurysm lumen.
C, Complete occlusion after coiling.
D, Angiogram after rebleeding 10 days after coiling, showing further enlargement of the aneurysm lumen with migration of the coils resulting in incomplete aneurysm occlusion.
E and F, Subtracted (E) and unsubtracted (F) angiogram after second coiling, showing near-total occlusion.
G and H, Subtracted (G) and unsubtracted (H) angiogram after second rebleeding 25 days after second coiling, again showing further enlargement of the aneurysm with migration of the coils.
- Fig 2.
Patient 2, a 68-year-old man with HH III SAH.
A, CT scan on admission shows small interhemispheric hematoma.
B, Angiogram on the day of admission shows small anterior communicating artery aneurysm pointing upward.
C, Pre-embolization angiogram 6 days later shows enlargement of the aneurysm thought to be caused by pseudoaneurysm formation. Note vasospasm in anterior and middle cerebral artery.
D—F, Lateral views before (D) and after (E and F) coiling, demonstrating a small neck remnant. There are no coils in the pseudoaneurysm. Note stasis of contrast agent in the pseudoaneurysm (F).
G and H, CT scan 16 days later, showing rebleeding and hydocephalus.
Tables
- TABLE 1:
Relevant patient and aneurysm characteristics of the six patients who suffered an early rebleeding after coiling of a ruptured aneurysm
Patient Number, Sex, and Age (years) Aneurysm Location and Size Treatment Delay after SAH (days) Clinical Condition at Time of Treatment Intracerebral Hematoma on Admission CT Initial Aneurysm Occlusion Rebleed Delay (days after coiling) Outcome (days after coiling) Angiogram after Rebleeding 1. F, 52 AcomA 6 mm 0 HH V Yes 100% 2 Death (2) No 2. M, 68 AcomA 5 mm 10 HH III Yes 100% 16 Death (21) No 3. F, 34 PcomA 4 mm 1 HH III Yes 100% 4 Death (15) Yes 4. M, 50 AcomA 5 mm 1 HH II No Residual aneurysm filling 2 Death (2) No 5. M, 53 AcomA 3, 5, 12 mm 12 HH V Yes 100% 10 and 35 Death (92) Yes (2×) 6. M, 26 AcomA 3 mm 4 HH IV Yes Residual aneurysm filling 7 Death (14) No Note.—HH indicates Hunt and Hess grading; AcomA, anterior communicating artery; PcomA, posterior communicating artery.
- TABLE 2:
Results of possible risk factors for early rebleeding after coiling of a ruptured aneurysm by multiple univariate logistic regression analysis
Variable OR 95% CI Adjacent hematoma 31.6 3.6–275.6 AcomA localization 11.1 1.3–95.9 Aneurysm size < 6 mm 10.6 1.2–91.8 Clinical condition HH III-V 8.9 1.0–76.8 Incomplete initial aneurysm occlusion 7.1 1.2–40.4 Timing of treatment after SAH < median 5 days 2.3 0.4–12.7 PcomA localization 0.9 0.1–8.1 Note.—CI indicates confidence interval; AcomA, anterior communicating artery; HH, Hunt and Hess grading; SAH, subarachnoid hemorrhage; PcomA, posterior communicating artery.
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