Low rate of rebleeding in the acute phase of treatment with embolization of intracranial ruptured aneurysms

Because aneurysm embolization does not immediately and completely isolate blood flow from the aneurysm as cranial clamping does, the rate of rebleeding after embolization has been one of the most important concerns of physicians. Previous large-case clinical trials have shown rebleeding rates of 1.4%-2.7% after embolization (including the Cerebral Aneurysm Rerupture After Treatment trial, the International Subarachnoid Aneurysm Trial, and the study on Early Rebleeding after Coiling of Ruptured Cerebral Aneurysms, reported rebleeding rates of 2.7%, 1.9%, and 1.4%, respectively). With the development of interventional materials and embolization techniques, the interventional treatment of aneurysms has been increasingly adopted. The above clinical trials were conducted on patients before 2004, which could not truly reflect the current rebleeding rate after aneurysm embolization. Therefore, Fleming JB et al. from the University of Alabama, USA, conducted a retrospective analysis by combining the data of multicenter cases from 2004 to 2009. The total number of cases in this study was 469 patients with ruptured intracranial aneurysms undergoing endovascular interventional embolization (including stent- or balloon-assisted embolization cases), and demographic and clinical data (e.g., gender, age, clinical presentation, aneurysm size and location, and MRS prognostic scores, etc.) were statistically analyzed.4 of 469 patients (0.9%) had re-rupture hemorrhage within 30 days of ruptured aneurysm embolization. Re-rupture bleeding occurred. Of the 4 patients with rerupture bleeding, 2 (50%) patients died; 1 (25%) had a rerupture bleeding after stent-assisted spring coil embolization. Moreover, there were no statistically significant differences in the embolization materials, techniques, or demographic factors used between cases of rerupture bleeding after embolization and patients who did not have another rupture bleed. This study statistically analyzed the data from a multicenter clinical trial over the last 5 years, and the results showed that with the development of embolization materials and embolization techniques, intracranial ruptured aneurysms can be treated with endovascular interventions with good clinical outcomes and a low probability of rerupture hemorrhage (0.9%).