Microembolic Signal Monitoring after Coiling of Unruptured Cerebral Aneurysms: An Observational Analysis of 123 Cases

Abstract

BACKGROUND AND PURPOSE: Thromboembolic events after aneurysm coiling are common, but the optimal algorithm for emboli prevention remains unclear. MESs correlate with the occurrence of impending ischemic events and may be used for management guidance. This study reports the use of MES monitoring with regard to aneurysm characteristics and coiling technique after a specific anticoagulation protocol.

Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases

“…In contrast to studies demonstrating the anticoagulation effect of heparin during coiling of cerebral aneurysms,14 23 26 27 we found no significant difference in the incidence of DWI lesions in patients with and those without heparinization. Since recent studies on humans lack a control group of patients without heparin treatment,14 23 26 27 no definite statement is possible about the appropriate anticoagulation regime. Notably, a swine model showed the effect of systemic heparinization on the in vivo thrombogenicity of various micro- and guiding catheters 30.…”

“…However, they evaluated only 20 patients with ruptured and unruptured aneurysms. In another approach applying microembolic signal monitoring, Schubert et al 23 compared the rate of embolic events in patients treated with stent-assisted coiling versus those treated with coiling alone. The authors observed no significant difference between the two procedures.…”

Heparin dosing is associated with diffusion weighted imaging lesion load following aneurysm coiling

“…A recent study described low occurrence of microembolic signals (MESs) on transcranial Doppler sonography with the use of a continuous heparin drip following coiling 30. While the vast majority of patients in this study received a continuous heparin drip during the first MES scan (96.7%), the incidence of MESs observed was in this group was lower than in the cases where heparin was not continued (3.4 vs 18.8 MESs/h).…”

Correlation Between Activated Clotting Time and Activated Partial Thromboplastin Time During Endovascular Treatment of Cerebral Aneurysms

“…In a recent study, Schubert et al show that early heparinization is associated with a lower incidence of micro-embolic signal monitoring [12]. Until now, literature does not provide clear recommendations about best anticoagulation scheme.…”