Safety and efficacy of management for intraprocedural rupture during endovascular treatment for intracranial aneurysms

Background Although intraprocedural rupture (IPR) is rare, it is a devastating complication of endovascular treatment (EVT) for intracranial aneurysms. Very few studies have been conducted on IPR, and the safety and efficacy of management techniques of IPR have not been investigated. Methods Patients who underwent IPR during EVT between 2013 and 2022 were enrolled from the multicenter observational registry. Focusing on the management of IPR, we examined its safety and efficacy using imaging markers, including increased hemorrhage and ischemic lesions evaluated using postoperative computed tomography and diffusion-weighted imaging, respectively. Results Of the 3269 EVT for intracranial aneurysms, 74 patients who underwent IPR (2.26%) were analyzed. Fifty-five patients (3.36%) experienced IPR in 1636 EVT cases for ruptured aneurysms. The multivariate analysis revealed that increased hemorrhage was significantly associated with poor outcomes (odds ratio [OR], 6.67 [95% confidence interval (CI), 1.07–41.44], p=0.042), whereas ischemic lesions were not. Regarding management techniques of IPR, antihypertensive medication use was significantly associated with increased hemorrhage (OR, 13.17 [95% CI, 2.26–76.69], p=0.004). Heparin reversal was an independent factor for ischemic lesions (OR, 4.81 [95% CI, 1.09–21.14], p=0.038). Conclusions Even though the setting of IPR may be miscellaneous, and optimal management varies depending on individual cases, heparin reversal might be associated with ischemic complications rather than being useful for controlling bleeding in IPR during EVT for ruptured aneurysms.