Stent-assisted coil emboilization of ruptured intracranial aneurysms

A retrospective multicenter review

Kiarash Golshani, Andrew Ferrell, Mark Lessne, Pratish Shah, Abhineet Chowdhary, Armen Choulakian, Michael J. Alexander, Tony P. Smith, David S. Enterline, Ali R. Zomorodi, Gavin W. Britz

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: The purpose of this study is to retrospectively review our experience with stent-assisted embolization of patients with an acutely ruptured cerebral aneurysm. Methods: Medical records and imaging were reviewed for 36 patients who underwent stent-assisted embolization of a ruptured cerebral aneurysm. Results: Seventeen patients (47%) received a preprocedural loading dose of clopidogrel and five patients (14%) received an intraprocedural dose of clopidogrel. The remaining 14 patients (36%) were treated with antiplatelet therapy following the procedure. Six (17%) stent related intraprocedural thromboembolic complications were encountered; four of these resolved (one partial, three complete) following treatment with abciximab and/or heparin during the procedure. Five of the six thromboembolic events occurred in patients who were not pretreated with clopidogrel (P = 0.043). Two patients in this series (6%) had a permanent thrombotic complication resulting in mild hemiparesis in one patient, and hemianopsia in the second. No procedure related hemorrhagic complications occurred in any patient. One patient had a spontaneous parenchymal hemorrhage contralateral to the treated aneurysm discovered 10 days after treatment. Twenty-eight patients (78%) had a Glasgow Outcome Score of 4 or better at discharge. Seven of 21 patients (33%) with angiographic follow-up required further treatment of the coiled aneurysm. Conclusion: Stent-assisted coil embolization is an option for treatment of ruptured wide neck ruptured aneurysms and for salvage treatment during unassisted embolization of ruptured aneurysms but complications and retreatment rates are higher than for routine clipping or coiling of cerebral aneurysms. Pretreatment with clopidogrel appears effective in reducing thrombotic complications without significant increasing risk of hemorrhagic complications.

Original languageEnglish (US)
Article number99174
JournalSurgical Neurology International
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2012

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Ruptured Aneurysm
Intracranial Aneurysm
Stents
clopidogrel
Aneurysm
Hemianopsia
Therapeutics
Salvage Therapy
Retreatment
Paresis
Diagnostic Imaging
Medical Records
Heparin
Neck

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Stent-assisted coil emboilization of ruptured intracranial aneurysms : A retrospective multicenter review. / Golshani, Kiarash; Ferrell, Andrew; Lessne, Mark; Shah, Pratish; Chowdhary, Abhineet; Choulakian, Armen; Alexander, Michael J.; Smith, Tony P.; Enterline, David S.; Zomorodi, Ali R.; Britz, Gavin W.

In: Surgical Neurology International, Vol. 3, No. 1, 99174, 01.01.2012.

Research output: Contribution to journalArticle

Golshani, K, Ferrell, A, Lessne, M, Shah, P, Chowdhary, A, Choulakian, A, Alexander, MJ, Smith, TP, Enterline, DS, Zomorodi, AR & Britz, GW 2012, 'Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review', Surgical Neurology International, vol. 3, no. 1, 99174. https://doi.org/10.4103/2152-7806.99174
Golshani, Kiarash ; Ferrell, Andrew ; Lessne, Mark ; Shah, Pratish ; Chowdhary, Abhineet ; Choulakian, Armen ; Alexander, Michael J. ; Smith, Tony P. ; Enterline, David S. ; Zomorodi, Ali R. ; Britz, Gavin W. / Stent-assisted coil emboilization of ruptured intracranial aneurysms : A retrospective multicenter review. In: Surgical Neurology International. 2012 ; Vol. 3, No. 1.
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abstract = "Background: The purpose of this study is to retrospectively review our experience with stent-assisted embolization of patients with an acutely ruptured cerebral aneurysm. Methods: Medical records and imaging were reviewed for 36 patients who underwent stent-assisted embolization of a ruptured cerebral aneurysm. Results: Seventeen patients (47{\%}) received a preprocedural loading dose of clopidogrel and five patients (14{\%}) received an intraprocedural dose of clopidogrel. The remaining 14 patients (36{\%}) were treated with antiplatelet therapy following the procedure. Six (17{\%}) stent related intraprocedural thromboembolic complications were encountered; four of these resolved (one partial, three complete) following treatment with abciximab and/or heparin during the procedure. Five of the six thromboembolic events occurred in patients who were not pretreated with clopidogrel (P = 0.043). Two patients in this series (6{\%}) had a permanent thrombotic complication resulting in mild hemiparesis in one patient, and hemianopsia in the second. No procedure related hemorrhagic complications occurred in any patient. One patient had a spontaneous parenchymal hemorrhage contralateral to the treated aneurysm discovered 10 days after treatment. Twenty-eight patients (78{\%}) had a Glasgow Outcome Score of 4 or better at discharge. Seven of 21 patients (33{\%}) with angiographic follow-up required further treatment of the coiled aneurysm. Conclusion: Stent-assisted coil embolization is an option for treatment of ruptured wide neck ruptured aneurysms and for salvage treatment during unassisted embolization of ruptured aneurysms but complications and retreatment rates are higher than for routine clipping or coiling of cerebral aneurysms. Pretreatment with clopidogrel appears effective in reducing thrombotic complications without significant increasing risk of hemorrhagic complications.",
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AU - Alexander, Michael J.

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