Comparison of Clinical Outcomes of Intracranial Aneurysms: Procedural Rupture versus Spontaneous Rupture | American Journal of Neuroradiology

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Fig 1.
Cerebral angiography demonstrates a right posterior communicating artery aneurysm (A). During coil embolization with balloon remodeling, the aneurysm was ruptured by a coil (B). Despite rapid obliteration of the ruptured aneurysm, the volume of subarachnoid hemorrhage was considerable (modified Fisher grade 3) (C).
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Fig 2.
Modified Rankin Scale scores at the 6-month posttreatment period.
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Fig 3.
Kaplan-Meier estimates of the rates of stable aneurysmal occlusion: procedural rupture group versus spontaneous rupture group.

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Table 1:

Comparison of patient characteristics

	PR Group (n = 19)	SR Group (n = 198)	P Value
Female	16 (84.2%)	116 (58.6%)	.047^{^a}
Mean age (yr)	53.6 ± 1.5	55.8 ± 1.0	.22
Mean aneurysm size (mm)	4.6 ± 0.5	6.5 ± 0.2	.01^{^a}
Aneurysm location			.15
Anterior cerebral artery	4 (21.1%)	93 (47.0%)
Middle cerebral artery	5 (26.3%)	35 (17.7%)
Internal carotid artery	9 (47.4%)	57 (28.8%)
Posterior circulation	1 (5.2%)	13 (6.5%)
Hunt and Hess scale^{^b}			.82
1	1 (5.3%)	7 (3.5%)
2	13 (68.4%)	123 (62.1%)
3	2 (10.5%)	36 (18.2%)
4	3 (15.8%)	26 (13.1%)
5	0 (0%)	6 (3.1%)
Modified Fisher grade			.03^{^a}
Small volume (grade 1)	14 (73.7%)	89 (45.0%)
Large volume (grades 2–4)	5 (26.3%)	109 (55.0%)

↵a Significant.
↵b Hunt and Hess scale grades were immediately assessed after the patient recovered from the anesthesia in the PR group and at admission in the SR group without adjustment of comorbidity.

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Table 2:

Comparison of embolization techniques and treatment procedures^{^a}

	PR Group (n = 19)	SR Group (n = 198)	P Value
Technique			<.01^{^b}
Single microcatheter	12 (63.2%)	108 (54.6%)
Double microcatheter	2 (10.4%)	65 (32.8%)
Balloon remodeling	4 (21.1%)	5 (2.5%)
Stent-assisted	1 (5.3%)	20 (10.1%)
Lumbar drainage			.23
Yes	6 (31.6%)	38 (19.2%)
No	13 (68.4%)	160 (81.2%)
Extraventricular drainage			.32
Yes	1 (5.3%)	34 (17.2%)
No	18 (94.7%)	164 (82.8%)
Decompressive craniectomy			1.00
Yes	0 (0%)	4 (2.0%)
No	19 (100%)	194 (98.0%)
Endovascular vasospasm therapy			.08
Yes	0 (0%)	32 (16.2%)
No	19 (100%)	166 (83.8%)
Permanent shunt			1.00
Yes	1 (5.3%)	19 (9.6%)
No	18 (94.7%)	179 (90.4%)

↵a Data are No. (%) unless otherwise indicated.
↵b Significant.

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Table 3:

Comparison of clinical outcome and imaging follow-up

	PR Group (n = 19)	SR Group (n = 198)	P Value
Mean hospitalization (day)	13.7 ± 3.1	18.4 ± 1.2	.25
Compromised outcome^{^a} (No.)	1 (5.3%)	53 (26.8%)	.049^{^b}
Follow-up imaging (No.)
Recanalization	1 (5.3%)	40 (20.2%)
Stable	14 (73.6%)	122 (61.7%)
Absence of follow-up imaging	4 (21.1%)	36 (18.1%)

↵a Modified Rankin Scale scores of ≥2 at postictus 6 months.
↵b Significant.

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Table 4:

Logistic regression model assessing risk factors of poor clinical outcome

Variables	Univariate Analysis			Multivariate Analysis
Variables	Odds Ratio	95% CI	P Value	Odds Ratio	95% CI	P Value
Age	1.051	1.024–1.079	.000^{^a}	1.053	1.020–1.087	.001^{^a}
Sex	1.016	0.541–1.909	.961	–	–	–
Hunt and Hess scale grade	4.874	3.075–7.725	.000^{^a}	4.565	2.608–7.989	.000^{^a}
Modified Fisher grade	9.868	4.203–23.167	.000^{^a}	2.867	1.053–7.809	.039^{^a}
SR	6.579	0.857–50.503	.070^{^a}	14.908	1.151–193.054	.039^{^a}

Note:— – indicates variable was not included in the multivariate analysis.
↵a Significant.

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