Objective
The purpose of this study was to report our clinical experience of Intra-procedural rupture (IPR) during endovascular treatment of cerebral aneurysm.
Methods 
Between January 2010 and October 2018, 19 times of IPR occurred in two center during endovascular treatment of cerebral aneurysm. Thirteen patients were women. Mean age was 57.1 years-old ranging from 26 to 77. Eleven cases were ruptured condition. Mean size of the aneurysms was 4.86mm ranging from 2.3 to 7.52mm.
Results
The most common location of IPR was anterior communicating artery (n=9). IPR developed at the procedural steps of coil framing (n=5), further coil packing (n=7), coil packing under stent jailing (n=6), and removal of coil delivery microcatheter after coiling (n=1). The locations of IPR were dome (n=9), bleb of the dome (n=5), neck (n=3), and trunk of dissecting aneurysm (n=2). In 5 cases, IPR occurred when the marker of coil delivery wire passed the proximal marker of the microcatheter. In 4 cases, the microcatheter protruded into subarachnoid space when packing coils into the aneurysm. IV heparin was used in 13 cases. Protamine sulfate for reversing heparin was in 4 cases. All cases of rescue management after IPR were performed without balloon occlusion. Additional stent was deployed in 2 cases. In all cases, angiographic occlusion of the aneurysm was eventually achieved. Compare with initial finding, change of hemodynamics in final angiography after coil embolization did not detected in any case. Mean contrast leakage time was 11.1 minutes ranging from 1 to 31 minutes. Immediate radiologic outcome was complete (n=12), residual neck (n=5), and residual sac (n=2). IPR related with focal neurological deficits developed in 2 patients all of who suffered from temporary motor weakness (grade IV). To control IICP or acute hydrocephalus, temporary external ventricular drain was performed in 8 cases (42.1%) but permanent VP shunt was performed in 2 cases presented initially with subarachnoid hemorrhage. 
Conclusions 
In our series, favorable clinical outcome may probably be expected if suitable rescue manage could be performed after IPR.

Intra-procedural rupture of aneurysm during endovascular treatment: two centers experience

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