Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: a cautionary report

Tumialán, Luis M.; Zhang, Y. Jonathan; Cawley, C. Michael; Dion, Jacques E.; Tong, Frank; Barrow, Daniel L.

doi:10.3171/jns/2008/108/6/1122

Cited by 140 publications

(95 citation statements)

References 20 publications

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“…Second, the risk of the vessel stenosis or the formation of thrombosis must also be considered. Because the stent can induce neointimal hyperplasia, thrombosis or occlusion of the smaller arteries, the necessity of dual antiplatelet therapy in conjunction with stent-assisted coil embolization increases the risk of intracranial hemorrhage and possibly rebleeding from a ruptured aneurysm 25) . The balloon-assisted technique, in which a non-detachable balloon is advanced into the parent artery and inflated to occlude the neck of aneurysm, stabilizes the microcatheter in the aneurysm during coil delivery and prevents the coil impinging on the parent artery.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon

YOUN

Lee

et al. 2010

J Korean Neurosurg Soc

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Objective : To assess the feasibility, safety, and effectiveness of the balloon-assisted technique with HyperForm balloon in the endovascular treatment of wide-necked intracranial aneurysms. Methods : A total of 34 patients with 34 wide-necked intracranial aneurysms were treated with endovascular coil embolization using balloonassisted technique with Hyperform balloon. Twenty-nine aneurysms (85.3%) were located in the anterior circulation. The group of patients was comprised of 16 men and 18 women, aged 33 to 72 years (mean : 60.6 years). The size of aneurysms was in the range of 2.0 to 22.0 mm (mean 5.5 mm) and one of neck was 2.0 to 11.9 mm (mean 3.8 mm). The dome to neck ratio was ranged from 0.83 to 1.43 (1.15). Sixteen patients were treated for unruptured aneurysms and the remaining 18 presented with a subarachnoid hemorrhage. Results : In the 34 aneurysms treated by the remodeling technique with HyperForm balloon, immediate angiographic results consisted of total occlusion in 31 cases (91.2%) and partial occlusion in three cases (8.8%). There were five procedure-related complications (14.7%), including two coil protrusions and three thromboembolisms; Except one patient, all were successfully resolved without permanent neurologic deficit. No new bleeding occurred during the follow-up. Twenty patients (59%) underwent angiographic follow-up from 2 to 33 months (mean 9.2 months) after treatment. Focal recanalization with coil compaction of the neck portion was observed in 5 cases (25%). Only one case showed major recanalization and underwent stent-assisted coil embolization. Conclusion :The balloon-assisted technique with Hyperform balloon is a feasible, safe, and effective endovascular treatment of wide-necked cerebral aneurysms. KEY WORDS :Intracranial aneurysms˙ Wide-necked aneurysms˙ Endovascular treatment˙ Balloon-assisted technique.

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Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon

YOUN

Lee

et al. 2010

J Korean Neurosurg Soc

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“…4 However, in the context of anticoagulant or antiplatelet therapy, ventriculostomy should be considered as a significant risk factor for hemorrhagic complications. 28,31 Antiplatelet agents inhibit the coagulation of bleeding from vessels injured by EVD, making the hemorrhage size larger. Kim et al 19 showed the hemorrhage risks associated with SAC.…”

Section: Discussionmentioning

confidence: 99%

Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications

Chung¹,

Lim

Suh

et al. 2014

JNS

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Object. The purpose of this study was to report the authors' experiences in stent-assisted coil embolization (SAC) of ruptured wide-necked aneurysms in the acute period and to evaluate the incidence of and risk factors for periprocedural complications.Methods. A total of 72 patients were recruited for this study between March 2007 and June 2012. All patients met the following criteria: 1) the presence of ruptured intracranial wide-necked saccular aneurysms, and 2) the patient underwent SAC for treatment of those aneurysms within 72 hours of rupture. All of the patients with clinically poor grades or acute hydrocephalus underwent external ventricular drainage (EVD) before SAC. The incidence of and risk factors for periprocedural complications were retrospectively evaluated.Results. Of the 72 patients included in this study, periprocedural complications occurred in 14 (19.4%), including asymptomatic complications in 4 (5.6%) and symptomatic complications in 10 (13.9%); there were symptomatic thromboembolic complications in 5 patients (6.9%), and symptomatic hemorrhagic complications in 5 (6.9%). The authors observed no subacute or delayed thromboembolic complications during the follow-up period of 18.8 months. Use of EVD (OR 1.413, 95% CI 0.088 -2.173; p = 0.046) was the only independent risk factor for periprocedural complications on multivariate logistic regression analysis.Conclusions. The periprocedural complication rate during SAC was 19.4% among 72 patients. Because of the high complication rate, microsurgical clipping or endovascular treatment with another technique (multiple-microcatheter or balloon-assisted technique) may be a more appropriate option for first-line treatment than SAC, especially in patients requiring EVD. (http://thejns.org/doi/abs/10.3171/2014.4.JNS131662) keY WorDS • periprocedural complication • ruptured intracranial aneurysm • stent-assisted coil embolization • wide-necked aneurysm • vascular disorders Abbreviations used in this paper: ACT = activated clotting time; EVD = external ventricular drainage; GOS = Glasgow Outcome Scale; GP = glycoprotein; IPH = intraparenchymal hemorrhage; SAC = stent-assisted coil embolization; SAH = subarachnoid hemorrhage.

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“…However dual antiplatelet therapy is necessary to prevent thromboembolism after stent placement and may increase the risk of intracranial hemorrhage or rebleeding from a ruptured aneurysm. 50 Because a ruptured AICA aneurysm is often accompanied by intraventricular hemorrhages, an intracranial procedure such as EVD should be carefully performed after dual antiplatelet therapy. In this study, 1 patient with stent-assisted coiling required EVD, which was performed without intracranial hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Management of Anterior Inferior Cerebellar Artery Aneurysms: Endovascular Treatment and Clinical Outcome

Suh

Kim

Kim³

et al. 2010

AJNR Am J Neuroradiol

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Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: a cautionary report

Cited by 140 publications

References 20 publications

Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon

Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon

Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications

Management of Anterior Inferior Cerebellar Artery Aneurysms: Endovascular Treatment and Clinical Outcome

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