SynthesisNeuroradiology2026
Intra-procedural re-rupture during endovascular coiling of ruptured intracranial aneurysms: a systematic review.
Synthesis in Neuroradiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundIntra-procedural re-rupture (IPRR) during endovascular treatment of ruptured intracranial aneurysms is a challenging potential complication. Evidence specific to re-rupture after subarachnoid hemorrhage (SAH) remains fragmented.
objectiveTo systematically review the incidence, mechanisms, anatomical risk factors, and outcomes of intra-procedural re-rupture during endovascular treatment of previously ruptured intracranial aneurysms.
methodsA PRISMA 2020–compliant systematic review was performed using PubMed and Scopus from inception through April 2025. Studies reporting intra-procedural re-rupture during endovascular treatment of ruptured saccular intracranial aneurysms were included. Data extracted included patient and aneurysm characteristics, procedural context, mechanisms of re-rupture, and clinical outcomes. Risk of bias was assessed using ROBINS-I and CARE tools.
resultsEleven studies encompassing 2,990 ruptured aneurysms reported 109 intra-procedural re-rupture events, yielding an incidence of 3.6%. Re-rupture occurred most frequently at the anterior communicating artery (34.9%). The predominant mechanisms were first- or framing-coil perforation (48.6%) and microcatheter or guidewire injury (18.3%). Overall mortality was 11.9%, and 59.6% of patients achieved favorable functional outcomes with successful hemostasis. Two illustrative cases from our institution demonstrate intra-procedural re-rupture following SAH, successfully managed with immediate balloon-assisted flow control.
conclusionsIntra-procedural re-rupture during the treatment of ruptured intracranial aneurysms is a high-risk procedural complication. Although infrequent, it is a critical determinant of outcome. Recognition of high-risk aneurysm features and procedural triggers, coupled with preparedness strategies such as pre-positioned balloon control, is essential to mitigate morbidity and mortality.
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