delayed rupture

INTRODUCTION: Rupture following flow diversion treatment has been reported as a complication of this technique. The aim of this survey was to investigate the efficacy of flow diversion by retrospectively analysing the rate of delayed ruptures in all centres using this technology. METHODS: A questionnaire based survey about thromboembolic and haemorrhagic complications related to flow diversion treatment, with focus on delayed ruptures, was distributed to clinical practitioners. Parenchymal haemorrhages were collected and analysed separately from aneurysmal bleeding. Detailed morphological and clinical data was available on a subgroup of 720 of 1421 aneurysms reported (Group 1). In another 581 cases detailed data was available on ruptured cases only. The full cohort of 1421 aneurysms in 1274 patients in Group 2 was used to calculate the incidence of delayed rupture. RESULTS: In Group 1 procedural thromboembolic complications were reported in 48 of 720 aneurysm treatments (6.7 %). Procedural parenchymal bleeds and subarachnoid haemorrhage occurred in 1.8 % and 14 delayed parenchymal bleeds (1.9 %) were reported. In Group 2, 14 delayed ruptures were reported (1 %), with 13 subarachnoid bleeds and a single case of carotid-cavernous fistula development. All ruptured aneurysms were >10 mm, with a mean maximal diameter of 24 mm. The median time to rupture after treatment was 9 days. The incidence of delayed rupture was 2.1 % in the subgroup of aneurysms >10mm. CONCLUSIONS: Delayed ruptures affected large aneurysms with a mean diameter of 24 mm, suggesting that very large to giant aneurysms are prone to this risk.