Complications of endovascular treatment for intracranial aneurysms: Management and prevention

Abstract

<jats:p> Endovascular coiling for intracranial aneurysms has become an accepted treatment with good clinical results and provides adequate protection against rebleeding and rupture of aneurysms. However, despite the experience, preparation, or skill of the physician, complications during endovascular treatment still occur. The main complications of endovascular coiling are: procedural aneurysmal perforations by the microcatheter, micro-guidewire, or coil, and thromboembolic events. Such situations are unexpected, complex, and can have devastating consequences. In this article, we present a comprehensive review of the two most common complications, aneurysmal perforation and thromboembolism during endovascular coiling, and how we can prevent or overcome these complications to achieve a satisfactory outcome. In addition, as the flow diverter has been become an important tool for management of large, wide necked, and other anatomically challenging aneurysms, we also describe complications stemming from the use of the tool, which remains a novel treatment option for complex aneurysms. </jats:p>

Feasibility of a customizable training environment for neurointerventional skills assessment

“…As intraoperative complications such as aneurysm perforation or thromboembolism can have fatal consequences, safe handling of neurointerventional materials is crucial [ 14 ]. Hence, not only optimal preoperative preparation of the patient–e.g.…”

“…Hence, not only optimal preoperative preparation of the patient–e.g. adequate indication, antiplatelet therapy etc.–but moreover a well-trained physician with sufficient technical skills are pivotal factors for procedural success [ 14 ]. The improvement of technical skills by means of simulator based angiography in neurosurgery has been previously demonstrated by Fargen et al [ 15 ].…”

Factors Associated with Procedural Thromboembolisms after Mechanical Thrombectomy for Acute Ischemic Stroke

“…Cerebral infarction on DWI after neurointerventional procedure may be caused by tiny thrombi, fragmented atherosclerotic plaques, air bubbles or hydrophilic coating materials from catheters and wires during catheter insertion or injection of contrast media or flushing saline [ 12 , 13 ]. Our multivariate analysis showed a significant relationship between procedural thromboembolisms and procedural time (adjusted OR; 1.020, 95% CI; 1.002–1.039, p = 0.030).…”

Success rate of simple coil embolization in wide-neck aneurysm with aneurysmal shoulder

“…Many literatures pointed out rate of the intraprocedural rupture of the aneurysm from endovascular treatment ranging between 1% and 5%. [ 9 16 ] This is one of the disadvantages of simple coiling when compare to balloon-assisted coiling, that using balloon can control hemorrhage after the incidence. Some studies also showed that balloon-assisted coiling do not increase rate of intra-procedural rupture.…”

“…Some studies also showed that balloon-assisted coiling do not increase rate of intra-procedural rupture. [ 16 ]…”