Correspondence

Rupture of Cerebral Aneurysm during Angiography

N Engl J Med 1999; 340:1442May 6, 1999

Article

To the Editor:

Dr. Stockinger's contribution to Images in Clinical Medicine (Dec. 10 issue)1 shows the fatal periangiographic rupture of an aneurysm of the posterior inferior cerebellar artery in a 35-year-old woman. Forceful injection of contrast medium into a vertebral artery to visualize the contralateral posterior inferior cerebellar artery through retrograde opacification of the contralateral vertebral artery is a procedure that has long been used in order to avoid the need for selective catheterization of both vertebral arteries during a workup for subarachnoid hemorrhage. It must be remembered, however, that the intraaneurysmal pressure is increased by the injection of contrast medium,2 and that the rise in pressure is correlated with the rate and volume of the injection.3

The maneuver thus appears to be inappropriate. It should be reserved for the small fraction of generally older patients with atheromatous vessels that preclude the safe, selective study of one vertebral artery, and then only after an ipsilateral aneurysm has been reasonably ruled out by a gentle injection of contrast medium. The injection of 6 ml of nonionic contrast material at a rate of 3 ml per second is generally sufficient to obtain an image of excellent quality with modern digital-subtraction angiographic equipment.

Philippe Gailloud, M.D.
Kieran J. Murphy, M.D.
Johns Hopkins Hospital, Baltimore, MD 21287

3 References

1. 1

   Stockinger Z. Rupturing aneurysm of the posterior inferior cerebellar artery. N Engl J Med 1998;339:1758-1758
   Full Text | Web of Science | Medline

2. 2

   Sorimachi T, Takeuchi S, Koike T, Minakawa T, Tanaka R. Intra-aneurysmal pressure changes during angiography in coil embolization. Surg Neurol 1997;48:451-457
   CrossRef | Web of Science | Medline

3. 3

   Saitoh H, Hayakawa K, Nichimura K, et al. Intracarotid blood pressure changes during contrast medium injection. AJNR Am J Neuroradiol 1996;17:51-54
   Web of Science | Medline

Author/Editor Response

The editor replies:

The points made by Drs. Gailloud and Murphy are well taken. Unfortunately, Dr. Stockinger is unable to supply any additional information about the procedure.

Jerome P. Kassirer, M.D.

Citing Articles (1)

Citing Articles

1. 1

   Mutsumi Nagai, Yuiko Koizumi, Junko Tsukue, Eiju Watanabe. (2008) A case of extravasation from a cerebral aneurysm during 3-dimensional computed tomography angiography. Surgical Neurology 69:4, 411-413
   CrossRef