Thromboembolism during coiling of intracranial aneurysms: predictors and clinical outcome

Abstract

Introduction: Thromboembolism is one of the most serious complications associated with coil embolization therapy. Aim: To identify predisposing factors for thromboembolic complications, as well as to determine whether thromboembolism has an impact on clinical outcome. Material and methods: From February 2008 to March 2015, 273 consecutive patients were treated at our institution via endovascular coil embolization. Patient medical records were reviewed with an emphasis on procedure description, potential risk factors and clinical outcomes related to thromboembolism. Thromboembolic incidents occurred in 19 (6.9%) cases. Multivariate logistic regression models were used to determine independent predictors of thromboembolism. Clinical outcome was analyzed using the Glasgow Outcome Scale (GOS). Results: Multivariate analysis showed that subarachnoid hemorrhage was an independent risk factor for thromboembolic complications (p = 0.003; OR = 4.4; 95% CI: 1.67-12.02). The difference in frequency of perioperative mortality (GOS 1) in patients with thromboembolism and without thromboembolism was not statistically significant (p = 0.22). The differences in frequencies of severe disability (GOS 2-3) and moderate to low disability between patients with thromboembolism and without thromboembolism were statistically significant in the general study population (p < 0.05). Conclusions: Subarachnoid hemorrhage is an independent predictor of thromboembolic complications associated with endovascular coiling of cerebral aneurysms. Thromboembolism is associated with significantly increased risk of morbidity, and it affects to a certain extent the periprocedural mortality.

Thrombectomy for delayed thromboembolism in a recurrent cerebral aneurysm previously treated with coiling: A case report

“…Thromboembolic events are severe complications associated with embolization therapy for cerebral aneurysms, with morbidity rates of up to 45% and mortality rates of up to 23%. [6] The exact mechanism underlying thromboembolic events after endovascular coiling is not fully understood, it is believed that disruption of the aneurysm wall plays a role. This disruption can lead to turbulent blood flow and thrombus formation, and the rough surfaces of the endovascular coils themselves can contribute to thrombus formation.…”

“…[5] However, it is worth noting that there is a risk of recurrent intracranial aneurysms (RAs) after clipping, with an occurrence rate of 5% to 9%. [6] The management of RAs following clipping poses significant challenges, prompting endovascular coiling to become the primary treatment option. Notably, thromboembolic events, though relatively rare (2%-4.9%), predominantly occur within the initial 72 hours post-procedure, with delayed embolism incidents accounting for <1% of cases.…”