Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling

Kung, David; Policeni, Bruno; Capuano, Ana W.; Rossen, James D.; Jabbour, Pascal; Torner, James C.; Howard, Matthew A.; Hasan, David

doi:10.3171/2010.9.jns10445

Cited by 135 publications

(83 citation statements)

References 29 publications

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“…However, this can complicate the inpatient management of attendant procedures for patients with SAH, especially EVD placement and removal, shunt placement, and decompressive craniectomy. Ventriculoperitoneal shunt-related ICH rates of up to 71% have been reported in patients concomitantly treated with dual antiplatelet agents after stent-assisted aneurysm coiling, 13,18 and a significantly increased risk of fatal hemorrhagic complications was reported with respect to dual antiplatelet therapy during stent-assisted aneurysm coiling by Mocco et al, who found a 12% risk of mortality in an SAH cohort relative to a 0.8% mortality in the unruptured aneurysm cohort. 21 All previously reported blister aneurysm flow-diversion treatment series described dual antiplatelet pretreatment prior to flow-diverter placement; similarly, all patients in our series also underwent preloading with aspirin and clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy

Ryan

Khan

Barco

et al. 2017

Neurosurgical Focus

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OBJECTIVERuptured blister aneurysms remain challenging lesions for treatment due to their broad, shallow anatomy and thin, fragile wall. Historical challenges with both open microsurgical approaches and intrasaccular endovascular approaches have led to increased use of flow diversion for management of these aneurysms. However, the optimum paradigm, including timing of treatment, use of dual antiplatelet therapy, and number of flow-diverter devices to use remains unknown. The authors describe their experience with ruptured blister aneurysms treated with flow diversion at their institution, and discuss rates of rebleeding and number of devices used.METHODSAll patients presenting with subarachnoid hemorrhage from a ruptured blister aneurysm and treated with Pipeline flow diversion were identified. Patient demographic data, clinical status and course, need for external ventricular drain (EVD), timing of treatment, and angiographic details and follow-up were recorded.RESULTSThere were 13 patients identified (11 women and 2 men), and 4 had multiple aneurysms. Two aneurysms were treated on initial angiography, with average time to treatment of 3.1 days for the remainder, after discussion with the family and institution of dual antiplatelet therapy. Device placement was technically successful in all patients, with 2 patients receiving 2 devices and the remainder receiving 1 device. There was 1 intraoperative complication, of a wire perforation causing intracerebral hemorrhage requiring decompressive craniectomy. Three patients had required EVD placement for management of hydrocephalus. There was no rebleeding from the target lesion; however, one patient had worsening intraventricular hemorrhage and another had rupture of an unrecognized additional aneurysm, and both died. Of the other 11 patients, 10 made a good recovery, with 1 remaining in a vegetative state. Nine underwent follow-up angiography, with 5 achieving complete occlusion, 2 with reduced aneurysm size, and 2 requiring retreatment for aneurysm persistence or enlargement. There were no episodes of delayed rupture.CONCLUSIONSPipeline flow diversion is a technically feasible and effective treatment for ruptured blister aneurysms, particularly in good-grade patients without hydrocephalus. Patients with a worse grade on presentation and requiring EVDs may have higher risk for bleeding complications and poor outcome. There was no rebleeding from the target lesion with use of a single device in this series.

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Section: Discussionmentioning

confidence: 99%

Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy

Ryan

Khan

Barco

et al. 2017

Neurosurgical Focus

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“…The risk of ventriculostomy-related hemorrhage is higher in patients with SAH treated with stent-assisted coiling than in those with coiling without a stent. 26 In this study, an EVD was placed in 10 of 40 patients, with ventriculostomy-related hemorrhage occurring in 2 of 5 patients whose EVD was placed before coiling. The hemorrhage was characterized by small petechial bleeding along the catheter tract, which was Ͻ1 cm in diameter, asymptomatic, and temporary.…”

Section: -12mentioning

confidence: 99%

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Kim¹,

Choi²,

Kang³

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Stent-assisted coiling of intracranial aneurysms requires antiplatelet therapy, typically aspirin and clopidogrel to prevent thromboembolic complications. There is a substantial concern that tirofiban may increase the risk of hemorrhage when used as an antiplatelet premedication in ruptured intracranial aneurysms. Our aim was to evaluate the safety and efficacy of intravenous tirofiban administration, instead of oral dual antiplatelet agents, as an antiplatelet premedication for stent-assisted coiling in patients with acutely ruptured intracranial aneurysms.

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“…9 Contrary to a series by Almekhlafi et al, 9 we did not use antiplatelet therapy; thus theoretically reducing the risk of hemorrhagic complications linked to intraprocedural rupture of the aneurysm and to subsequent surgical interventions to treat intracranial hypertension such as EVD placement or decompressive craniectomy. 16 In our series, 4 of the 8 patients underwent emergent EVD placement, and no hemorrhagic complication was noted. Moreover, 1 patient had an intraoperative aneurysm rupture that was successfully managed by coil packing.…”

Section: Discussionmentioning

confidence: 58%

Temporary Solitaire Stent-Assisted Coiling: A Technique for the Treatment of Acutely Ruptured Wide-Neck Intracranial Aneurysms

Signorelli

Gory

Turjman

2013

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Wide-neck intracranial aneurysms in patients with acute SAH are often challenging lesions to treat by neurosurgical and endovascular approaches. The aim of this study was to investigate the feasibility, safety, and efficacy of the use of temporary Solitaire AB stent-assisted technique with coiling for the treatment of acutely ruptured wide-neck aneurysms without perioperative antiplatelet therapy.

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Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling

Abstract: The application of dual antiplatelet therapy in stent-assisted coiling of acutely ruptured aneurysms is associated with an increase in the risk of hemorrhagic complications following ventriculostomy or VP shunt placement, as compared with its use in a coiling procedure without a stent.

Cited by 135 publications

References 29 publications

Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy

Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Temporary Solitaire Stent-Assisted Coiling: A Technique for the Treatment of Acutely Ruptured Wide-Neck Intracranial Aneurysms

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