Early Rebleeding after Coiling of Ruptured Cerebral Aneurysms: Incidence, Morbidity, and Risk

BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of early rebleeding after coiling of a ruptured cerebral aneurysm, assess the clinical outcome, and identify risk factors for this event. METHODS: Early rebleedings occurred in 6/431 (1.4%) consecutive patients after coiling of a ruptured aneurysm. Clinical condition at the time of treatment, aneurysm location and size, initial aneurysm occlusion, timing of coiling, and the presence of an adjacent intracerebral hematoma in the six patients with early rebleedings were compared with the remaining 425 patients. RESULTS: Incidence of early rebleeding after coiling of a ruptured aneurysm was 1.4%, and mortality was 100%. Independent risk factors are the presence of an adjacent intracerebral hematoma and small aneurysm size. Dependant risk factors are location on the anterior communicating artery, initial incomplete aneurysm occlusion, and poor clinical condition at the time of treatment. CONCLUSION: Early rebleeding after coiling of ruptured aneurysms is a major concern, in particular because the mortality is very high. A more restricted postembolization anticoagula-tion strategy in high-risk aneurysms may possibly prevent the occurrence of this devastating event. Surgical or endovascular treatment of ruptured cere-bral aneurysms is aimed at the prevention of rebleed-ings with the lowest possible risk of procedural com-plications. Because the risk of rebleeding is highest in the first hours and days after subarachnoid hemor-rhage (SAH), early treatment is advocated. It is gen-erally assumed that both surgery and coiling are ef-fective in preventing early rebleedings (1–4). We reviewed our data base of 431 consecutive patients who, over an 8-year period, were treated with coils for ruptured aneurysms. We assessed the incidences of early rebleeding after coiling of a ruptured cerebral aneurysm, evaluated the clinical outcomes, and tried to identify risk factors for this event