• Sakyo Hirai, Ryoichi Hanazawa, Masataka Yoshimura, Keigo Shigeta, Yohei Sato, Naoki Taira, Yoshihisa Kawano, Jun Karakama, Yoshiki Obata, Mutsuya Hara, Kenji Yamada, Yosuke Ishii, Kana Sawada, Shogo Imae, Hikaru Wakabayashi, Hirotaka Sagawa, Kyohei Fujita, Shoko Fujii, Satoru Takahashi, Akihiro Hirakawa, Shigeru Nemoto, and Kazutaka Sumita.
• Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
• Neurosurgery. 2024 Aug 1.

Background And ObjectivesAlthough 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.MethodsPatients who experienced IPR during EVT between 2013 and 2022 were enrolled from a multicenter observational registry. We examined the safety and efficacy of the management of IPR using imaging markers, including increased hemorrhage and ischemic lesions, which were evaluated using postoperative computed tomography and diffusion-weighted imaging, respectively.ResultsOf the 3269 EVTs for intracranial aneurysms, 74 patients who experienced IPR (2.26%) were analyzed. Fifty-five patients (3.36%) experienced IPR among 1636 EVT cases for ruptured aneurysms. Multivariate analysis revealed that increased hemorrhage was significantly associated with poor outcomes (odds ratio [OR], 6.37 [95% CI, 1.00-40.51], P = .050), whereas ischemic lesions were not. Regarding management techniques of IPR, antihypertensive medication use was significantly associated with increased hemorrhage (OR, 14.16 [95% CI, 2.35-85.34], P = .004). Heparin reversal was an independent factor for ischemic lesions (OR, 8.92 [95% CI, 1.54-51.58], P = .014).ConclusionAlthough the setting of IPR may be miscellaneous, and optimal management varies depending on individual cases, heparin reversal might be associated with ischemic complications, and its role in the successful hemostasis in IPR during EVT for ruptured aneurysms remains unclear.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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