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

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Axial DW MR image demonstrating typical punctate abnormalities related to thromboembolic phenomena occurring after an endovascular procedure.

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    Bar graph showing the percentage of patients with DW imaging abnormalities as a function of procedure type. N = no DW abnormalities; Y = yes (DW abnormalities present).

  • View in gallery

    Bar graph showing the percentage of patients with DW imaging abnormalities as a function of procedure type and presentation. Only patients with DW imaging abnormalities related to the procedure are represented in this graph.

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