Abstract WP125: Small Aneurysm Size is a Predisposing Factor for Intraprocedural Rupture During Coil Embolization of Unruptured Intracranial Aneurysms

Abstract

Introduction: Intraprocedural rupture(IPR) is one of the most severe complications during coil embolization of intracranial aneurysms. The incidence of IPR during endovascular coiling has been estimated to be 1-8.7%; however, few studies have focused exclusively on unruptured aneurysms. The aim of the present study is to evaluate the predisposing factors for IPR during coil embolization of unruptured intracranial aneurysms. Methods: This study included 254 consecutive patients with 281 unruptured intracranial aneurysms treated with endovascular coiling between April 2013 to March 2018 at our institution (mean age 61.7, range 26-88). Dissecting aneurysms and repeated endovascular procedures in recurrent aneurysms were excluded. The medical records were reviewed retrospectively and the following data were collected: age; gender; medical history; smoking habit; family history of intracranial aneurysm; presence or absence of multiple aneurysms; history of earlier subarachnoid hemorrhage from another aneurysm; aneurysm location, size and morphology; and procedural details. The mechanisms of IPR were also investigated. Univariate and multivariate analyses were conducted to determine independent predictors of IPR. Results: The incidence of IPR was 4.2%(12 of 281 endovascular procedures). The most common mechanism of IPR was perforation by coils. In the univariate analysis, IPR was associated with aneurysm size(less than 5mm)[odds ratio(OR) 4.8, 95% confidence interval(CI) 1.44-15.88, p=0.005], aneurysms of the anterior communicating artery(OR 4.6, CI 1.39-15.35, p=0.007), aneurysms of the basilar artery(OR 4.4, CI 1.10-17.56, p=0.024) and history of earlier subarachnoid hemorrhage from another aneurysm(OR 5.8, CI 1.10-30.30, p=0.020). There was no significant association between IPR and treatment modality. Multivariate logistic regression analysis proved that the size of aneurysm(less than 5mm) was an independent factor associated with IPR(OR 6.9, CI 1.24-38.52, p=0.027). Conclusion: This study suggests the association of the size of aneurysm with incidence of IPR during coil embolization for unruptured intracranial aneurysms. Small aneurysms less than 5mm are associated with increased risk of IPR during coil embolization.