Clinical Analysis of Fever, Headache, and Gastrointestinal Symptoms after Endosaccular Coil Embolization in Patients with Unruptured Cerebral Aneurysms— A Study of “Post Coiling Syndrome”

Abstract

Objective: Unidentified fever, headache, and gastrointestinal symptoms after endosaccular coil embolization are occasionally observed in patients with unruptured cerebral aneurysms. We defined these symptoms as post coiling syndrome (PCS) and analyzed the clinical risk factors involved. Methods:We applied the PCS diagnostic criteria based on the scoring of symptoms, which include fever, headache, nausea, and/or vomiting. Thirty-six consecutive patients were included in this retrospective study. Systematic follow-up included clinical and blood examinations.Results: Based on our criteria, 11 of 36 patients were diagnosed with PCS. Between patients in the PCS group and patients in the non-PCS group, we recognized significant differences in age (63.4 ± 12.5 vs. 53.8 ± 12.9, respectively; p <0.029) as patient background and in aneurysmal diameter (9.96 ± 4.24 vs. 6.48 ± 3.06, respectively; p <0.049), aneurysmal volume (242 ± 254 vs. 87.9 ± 70.1, respectively; p <0.015), total coil length (122 ± 106 vs. 39.1 ± 25.7, respectively; p <0.0021), and volume embolization ratio as aneurysmal data (41.9 ± 8.1 vs. 30.7 ± 8.5, respectively; p <0.0019). In addition, we recognized a significant difference in postoperative leukocytosis as an inflammatory factor. Conclusions:Patient age, aneurysmal diameter, aneurysmal volume, total coil length, and volume embolization may enable the prediction of PCS.

Post Coiling Syndrome Might Predict Recurrence after Coil Embolization of Unruptured Cerebral Aneurysms

“…9) We noticed the occurrence of headache, fever, and gastrointestinal symptoms in some patients 24-48 hours after endovascular coil embolization of unruptured cerebral aneurysms, proposed PCS as a disease concept, and reported cases. 1) Since the condition was observed more frequently in patients with a larger aneurysm size, a greater amount of coils used, and a higher coil packing rate and those who showed postoperative enhancement of inflammatory reaction, we have considered that PCS is caused by immunological reaction to coils as foreign bodies. 1) Since these conditions resembled the above-mentioned risk factors for recurrence observed in the literature, we evaluated the middle-to long-term results over a mean follow-up period of 53 months.…”

“…1) Since the condition was observed more frequently in patients with a larger aneurysm size, a greater amount of coils used, and a higher coil packing rate and those who showed postoperative enhancement of inflammatory reaction, we have considered that PCS is caused by immunological reaction to coils as foreign bodies. 1) Since these conditions resembled the above-mentioned risk factors for recurrence observed in the literature, we evaluated the middle-to long-term results over a mean follow-up period of 53 months. As a result, the recurrence was observed significantly more frequently in patients who presented with PCS despite the smallness of the number of patients while other factors were not significantly related to the recurrence rate.…”

“…The patients were classified into the PCS or non-PCS group 24-48 hours after embolization. 1) We followed up the patients every 6 months after embolization by MRA and plain radiography of the head. Cerebral angiography was performed, in principle, 1 year after embolization or when recurrence was suspected by MRA or plain radiography of the head.…”