Frequency of thromboembolic events associated with endovascular aneurysm treatment: retrospective case series

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  • 1 Departments of Neurological Surgery and Interventional Neuroradiology, and
  • 2 Biostatistics and Medical Informatics, University of Wisconsin at Madison, Wisconsin
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Object

There is little evidence addressing whether procedures requiring adjunctive devices lead to an increased frequency of thromboembolic complications. The authors report their experience with 155 aneurysms treated with and without adjunctive devices.

Methods

The authors retrospectively reviewed their last 155 aneurysm coil placement procedures. The patients' records were reviewed for the following phenomena: 1) evidence of procedure-related thrombus formation; 2) clinical evidence of stroke; and 3) the presence of acute ischemia in the treated vascular territory on diffusion-weighted (DW) imaging.

Results

Of the 155 aneurysms treated in 132 patients, 66 were treated with coils only, 45 had stent-assisted coil placement, 33 underwent balloon remodeling, and in 11 stents were placed after balloon remodeling. Small DW imaging abnormalities were present in the treated vascular territory in 24% of cases (37 lesions). Specifically, 21 (32%) of 66 lesions in the coil-treated group, 6 (13%) of 45 in the stent-assisted coil treatment group, 8 (24%) of 33 in the balloon remodeling group, and 2 (18%) of 11 in the balloon and stent group showed DW imaging positivity. Furthermore, 25 (68%) of the 37 cases that were positive on DW imaging occurred in patients presenting with subarachnoid hemorrhage (SAH). Clinically evident stroke or transient ischemic attack was present in 10 (27%) of 37 cases, with 70% occurring in patients presenting with SAH.

Conclusions

Use of adjunctive devices in treating aneurysms does not appear to increase the frequency of embolic or ischemic events. The presence of DW imaging abnormalities and clinically evident stroke was actually less frequent when adjunctive devices were used and in electively treated cases. This was probably related to perioperative antiplatelet medical management.

Abbreviations used in this paper: DW = diffusion-weighted; MR = magnetic resonance; SAH = subarachnoid hemorrhage; TIA = transient ischemic attack.

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Contributor Notes

Address correspondence to: Aquilla S. Turk, D.O., Department of Radiology, Room E3/372, Box 3252, 600 Highland Avenue, University of Wisconsin at Madison, Wisconsin. email: turk@musc.edu.
  • 1

    Albayram S, , Selcuk H, , Kara B, , Bozdag E, , Uzma O, & Kocer N, : Thromboembolic events associated with balloon-assisted coil embolization: evaluation with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 25:17681777, 2004

    • Search Google Scholar
    • Export Citation
  • 2

    Bendszus M, , Koltzenburg M, , Bartsch AJ, , Goldbrunner R, , Gunthner-Lengsfeld T, & Weilbach FX, : Heparin and air filters reduce embolic events caused by intra-arterial cerebral angiography: a prospective, randomized trial. Circulation 110:22102215, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Cottier JP, , Pasco A, , Gallas S, , Gabrillargues J, , Cognard C, & Drouineau J, : Utility of balloon-assisted Guglielmi detachable coiling in the treatment of 49 cerebral aneurysms: a retrospective, multicenter study. AJNR Am J Neuroradiol 22:345 351, 2001

    • Search Google Scholar
    • Export Citation
  • 4

    Crawley F, , Stygall J, , Lunn S, , Harrison M, , Brown MM, & Newman S: Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty. Stroke 31:13291334, 2000

    • Search Google Scholar
    • Export Citation
  • 5

    Cronqvist M, , Wirestam R, , Ramgren B, , Brandt L, , Nilsson O, & Saveland H, : Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results, MR findings and clinical outcome. Neuroradiology 47:855873, 2005

    • Search Google Scholar
    • Export Citation
  • 6

    Derdeyn CP, , Cross DTI, , Moran CJ, , Brown GW, , Pilgram TK, & Diringer MN, : Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 96:837843, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Fujii Y, , Takeuchi S, , Sasaki O, , Minakawa T, , Kolke T, & Tanaka R: Hemostasis in spontaneous subarachnoidal hemorrhage. Neurosurgery 37:226234, 1995

    • Search Google Scholar
    • Export Citation
  • 8

    Geremia G, , Haklin M, & Brennecke L: Embolization of experimentally created aneurysms with intravascular stent devices. AJNR Am J Neuroradiol 15:12231231, 1994

    • Search Google Scholar
    • Export Citation
  • 9

    Guglielmi G, , Vinuela F, , Sepetka I, & Macellari V: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:17, 1991

    • Search Google Scholar
    • Export Citation
  • 10

    Hadeishi H, , Suzuki A, , Yasui N, , Hatazawa J, & Shimosegawa E: Diffusion-weighted magnetic resonance imaging in patients with subarachnoid hemorrhage. Neurosurgery 50:741748, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Lanterna LA, , Tredici G, , Dimitrov BD, & Biroli F: Treatment of unruptured cerebral aneurysms by embolization with guglielmi detachable coils: case-fatality, morbidity, and effectiveness in preventing bleeding—a systematic review of the literature. Neurosurgery 55:767775, 2004

    • Search Google Scholar
    • Export Citation
  • 12

    Lefkowitz MA, , Gobin YP, , Akiba Y, , Duckwiler GR, , Murayama Y, & Guglielmi G, : Balloon-assisted Guglielmi detachable coiling of wide-necked aneurysms: Part II—clinical results. Neurosurgery 45:531538, 1999

    • Search Google Scholar
    • Export Citation
  • 13

    Malek AM, , Halbach VV, , Phatouros CC, , Lempert TE, , Meyers PM, & Dowd CF, : Balloon-assist technique for endovascular coil embolization of geometrically difficult intracranial aneurysms. Neurosurgery 46:13971407, 2000

    • Search Google Scholar
    • Export Citation
  • 14

    Molyneux A, , Kerr R, , Stratton I, , Sandercock P, , Clarke M, & Shrimpton J, : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:12671274, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Moret J, , Cognard C, , Weill A, , Castaings L, & Rey A: [Reconstruction technic in the treatment of wide-neck intracranial aneurysms: Long-term angiographic and clinical results. Apropos of 56 cases.]. J Neuroradiol 24:3044, 1997. (Fr)

    • Search Google Scholar
    • Export Citation
  • 16

    Nelson PK, & Levy DI: Balloon-assisted coil embolization of wide-necked aneurysms of the internal carotid artery: medium-term angiographic and clinical follow-up in 22 patients. AJNR Am J Neuroradiol 22:1926, 2001

    • Search Google Scholar
    • Export Citation
  • 17

    Pelz DM, , Lownie SP, & Fox AJ: Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 19:15411547, 1998

    • Search Google Scholar
    • Export Citation
  • 18

    Qureshi AI, , Luft AR, , Sharma M, , Guterman LR, & Hopkins LN: Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II—Clinical aspects and recommendations. Neurosurgery 46:13601376, 2000

    • Search Google Scholar
    • Export Citation
  • 19

    Qureshi AI, , Mohammad Y, , Yahia AM, , Luft AR, , Sharma M, & Tamargo RJ, : Ischemic events associated with unruptured intracranial aneurysms: multicenter clinical study and review of the literature. Neurosurgery 46:282289, 2000

    • Search Google Scholar
    • Export Citation
  • 20

    Rordorf G, , Bellon RJ, , Budzik RF Jr, , Farkas J, , Reinking GF, & Pergolizzi RS, : Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion-weighted imaging. AJNR Am J Neuroradiol 22:510, 2001

    • Search Google Scholar
    • Export Citation
  • 21

    Soeda A, , Sakai N, , Murao K, , Sakai H, , Ihara K, & Yamada N, : Thromboembolic events associated with Guglielmi detachable coil embolization with use of diffusion-weighted MR imaging. Part II. Detection of the microemboli proximal to cerebral aneurysm. AJNR Am J Neuroradiol 24:20352038, 2003

    • Search Google Scholar
    • Export Citation
  • 22

    Soeda A, , Sakai N, , Sakai H, , Iihara K, , Yamada N, & Imakita S, : Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol 24:127132, 2003

    • Search Google Scholar
    • Export Citation
  • 23

    Tsumoto T, , Terada T, , Tsuura M, , Matsumoto H, , Masuo O, & Yamaga H, : Diffusion-weighted imaging abnormalities after percutaneous transluminal angioplasty and stenting for intracranial atherosclerotic disease. AJNR Am J Neuroradiol 26:385389, 2005

    • Search Google Scholar
    • Export Citation
  • 24

    van Rooij WJ, , Sluzewski M, , Beute GN, & Nijssen PC: Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 27:14981501, 2006

    • Search Google Scholar
    • Export Citation
  • 25

    Wiebers DO, , Huston J III, , Meissner I, , Brown RD Jr, , Piepgras DG, & Forbes GS, : Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103110, 2003

    • Search Google Scholar
    • Export Citation

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