OBJECTIVE: To evaluate the postprocedural hemorrhagic complications associated with stent-remodeled coil embolization of intracranial aneurysms. METHODS: From the database of 163 cases of stent-remodeled therapy for wide-neck intracranial aneurysms, patients who showed intracranial hemorrhagic complications on follow-up brain imaging were selected. The initial presentation, antithrombotic medication, hemorrhagic type, location, amount, association with ventriculostomy, symptomatic involvement, and outcome were assessed. RESULTS: Ten patients (6.1%) developed intracranial hemorrhagic complications (range; 0-422 days; mean; 56 days). The hemorrhagic complication rate was higher in patients with acute subarachnoid hemorrhage (20%, 6 of 30 patients) than in patients with unruptured aneurysms (3%, 4 of 133 patients). Nine of the 10 patients were on dual-antiplatelet therapy at the time of hemorrhage development. Seven of the hemorrhages developed in patients with ventriculostomies (intraparenchymal, n=4; subdural hematoma, n=3). Three patients who did not receive a ventriculostomy also developed intracranial hemorrhage (n=1) or intraparenchymal hemorrhage (n=2). Hemorrhagic transformation in the recently infarcted brain tissue seemed to be the cause of nonventriculostomy related intraparenchymal hemorrhage. The hemorrhages were accompanied by symptomatic aggravation in 6 of 10 cases, with 5 cases resulting in moribund clinical outcome. CONCLUSION: Postprocedural intracranial hemorrhage may be a risk of stent-remodeled therapy while the patient is on dual-antiplatelet medication. Extra caution is warranted especially in patients with acute subarachnoid hemorrhage requiring ventriculostomy or with underlying recent brain infarction.
OBJECTIVE: To evaluate the postprocedural hemorrhagic complications associated with stent-remodeled coil embolization of intracranial aneurysms. METHODS: From the database of 163 cases of stent-remodeled therapy for wide-neck intracranial aneurysms, patients who showed intracranial hemorrhagic complications on follow-up brain imaging were selected. The initial presentation, antithrombotic medication, hemorrhagic type, location, amount, association with ventriculostomy, symptomatic involvement, and outcome were assessed. RESULTS: Ten patients (6.1%) developed intracranial hemorrhagic complications (range; 0-422 days; mean; 56 days). The hemorrhagic complication rate was higher in patients with acute subarachnoid hemorrhage (20%, 6 of 30 patients) than in patients with unruptured aneurysms (3%, 4 of 133 patients). Nine of the 10 patients were on dual-antiplatelet therapy at the time of hemorrhage development. Seven of the hemorrhages developed in patients with ventriculostomies (intraparenchymal, n=4; subdural hematoma, n=3). Three patients who did not receive a ventriculostomy also developed intracranial hemorrhage (n=1) or intraparenchymal hemorrhage (n=2). Hemorrhagic transformation in the recently infarcted brain tissue seemed to be the cause of nonventriculostomy related intraparenchymal hemorrhage. The hemorrhages were accompanied by symptomatic aggravation in 6 of 10 cases, with 5 cases resulting in moribund clinical outcome. CONCLUSION: Postprocedural intracranial hemorrhage may be a risk of stent-remodeled therapy while the patient is on dual-antiplatelet medication. Extra caution is warranted especially in patients with acute subarachnoid hemorrhage requiring ventriculostomy or with underlying recent brain infarction.
Authors: C J O'Kelly; J Spears; M Chow; J Wong; M Boulton; A Weill; R A Willinsky; M Kelly; T R Marotta Journal: AJNR Am J Neuroradiol Date: 2012-08-02 Impact factor: 3.825
Authors: Zeynep Vardar; Robert M King; Afif Kraitem; Erin T Langan; Lindsy M Peterson; Benjamin H Duncan; Christopher M Raskett; Vania Anagnostakou; Matthew J Gounis; Ajit S Puri; Giovanni J Ughi Journal: J Neurointerv Surg Date: 2020-09-28 Impact factor: 8.572