Endovascular Treatment of Ruptured Intracranial Aneurysms

Aneurysmal subarachnoid hemorrhage (SAH) is a catastrophic neurologic event. Early triage of patients with SAH should include cardiopulmonary stabilization, neurologic assessment, and imaging. Conventional angiography with 3-dimensional rendering is necessary to accurately assess aneurysm morphology and location, so that treatment can be planned appropriately. Current evidence suggests that coil embolization can be beneficial for aneurysms amenable to endovascular treatment. The use of remodeling techniques has expanded the range of aneurysms treatable by endovascular means. Balloon remodeling can be a powerful technique for treating ruptured aneurysms with unfavorable morphology. However, stent-assisted technique is associated with significantly higher complication rates in ruptured aneurysms and requires dual antiplatelet agents, and should therefore be considered with great caution for ruptured aneurysms. Complications of ruptured aneurysm embolization include aneurysm perforation, which should be addressed with immediate occlusion of the aneurysm, and thromboembolism, which can be managed most effectively with glycoprotein IIb/IIIa inhibitors.