Safety of Preprocedural Antiplatelet Medication in Coil Embolization of Ruptured Cerebral Aneurysms at the Acute Stage

Abstract

<jats:p> Preoperative antiplatelet medication for aneurysm coil embolization during acute subarachnoid hemorrhage (SAH) is not common. However, recent advances in neurointerventional devices make antiplatelet medication necessary for SAH surgery. We tested the hypothesis that preprocedural antiplatelet therapy in the acute stage of SAH prevents complications due to ischemia or induced bleeding. </jats:p><jats:p> We retrospectively reviewed 35 consecutive ruptured cerebral saccular aneurysms that underwent coiling at our institute. Two hundred milligrams of aspirin and 150 mg of clopidogrel were administered to the patients at least two hours before coiling. Systemic heparinization was given after sheath insertion. Procedure-related thrombus formation on digital subtraction angiography, and clinical evidence of ischemia and procedure-related stroke on CT were reviewed. </jats:p><jats:p> The median patient age was 69 years. Five males and 30 females were included. Seventy-seven percent of patients were Hunt-Hess grades 1 to 3. Assist techniques were used in 20 cases (57%). We inserted one extracranial internal carotid artery stent, but no intracranial stent. Intraoperative thrombosis occurred in one case (2.9%), with no clinical symptoms. Postoperative cerebrospinal fluid drainage was done in three cases, but we experienced no bleeding complications. </jats:p><jats:p> Preoperative antiplatelet therapy leads to a low rate of thromboembolic events in coiling during acute stage SAH, and this strategy had no adverse influence on bleeding complications. </jats:p>

Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review

“…Further detailed analysis of patients in the International Subarachnoid Aneurysm Trial (ISAT)26 found that standard antiplatelet therapy did not affect the outcome at discharge or at the 1 year follow-up in patients with SAH. Shimamura et al 27 found that preprocedural antiplatelet medication did not affect the outcome of 35 consecutive SAH patients. In addition, Kato et al 28 investigated the influence of previous antiplatelet usage before stroke on the outcome of SAH patients with age.…”

Dynamic Change in Mean Platelet Volume and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

“…The safety and efficacy of antiplatelet therapy in aSAH have been proven (30)(31)(32). Antiplatelet therapy can improve the functional outcome in patients and reduce their risk of DCI.…”

Safety of coiling with stent placement for the treatment of ruptured wide-necked intracranial aneurysms: a contemporary cohort study in a high-volume center after improvement of skills and strategy

“…A recent systematic review showed that com- plications of stent-assisted coiling for ruptured aneurysms may be affected by the method of antiplatelet administration. 15 Dual-antiplatelet medication with aspirin and clopidogrel 12,16 and monoantiplatelet therapy 1,2,6 have all been proved to be feasible for perioperative use on acutely ruptured aneurysms, and there is little consensus regarding the appropriate timing and dosage for antiplatelet agent administration, so further studies are required to establish the guidelines for perioperative antiplatelet strategy on stentassisted coiling for acutely ruptured aneurysms. 2) There is a changing strategy of case selection of coiling with stent placement in ruptured aneurysms.…”