Risk and prognostic factors for intraprocedural rupture during endovascular treatment for unruptured intracranial aneurysm: Insights from JR-NET4

BACKGROUND AND PURPOSE: Intraprocedural rupture is a rare but serious complication during endovascular treatment for unruptured intracranial aneurysms. We aim to identify risk and prognostic factors for intraprocedural rupture using data from a nationwide registry in Japan. MATERIALS AND METHODS: Data from 13,524 procedures were obtained. Poor clinical outcome was defined as a 30-day mRS score of 3-6. Logistic regression was used to determine predictors of intraprocedural rupture and poor clinical outcome after intraprocedural rupture. RESULTS: Intraprocedural rupture occurred in 164 procedures (1.21%). Multivariate analysis showed that female sex (OR 2.27, 95% CI 1.48-3.50), remodeling balloon catheter use (OR 1.43, 95% CI 1.03-1.99), and anterior communicating artery (OR 2.40, 95% CI 1.55-3.70) and posterior communicating artery (OR 1.58, 95% CI 1.03-2.44) aneurysms were independently associated with intraprocedural rupture. Retreatment was associated with a lower risk for intraprocedural rupture(OR 0.36, 95% CI 0.16-0.82). Poor clinical outcomes and 30-day mortality were more frequent in the intraprocedural rupture group (17.9% and 4.88%, respectively). CONCLUSIONS: Intraprocedural rupture was associated with poor clinical outcomes. Identification of patients at high risk for intraprocedural rupture may help improve procedural safety and clinical outcomes.