INTRODUCTION: Thromboembolic events are the primary complications encountered during endovascular treatment (EVT) of intracranial aneurysms. Intraprocedural heparinization is common during EVT but is less common post-procedure. The safety of heparinization following EVT is unknown, especially for ruptured aneurysms. MATERIALS AND METHODS: The records of 138 consecutive patients at our institution from 1 January 2000 to 30 June 2007 who were treated with EVT for 140 ruptured intracranial aneurysms were reviewed. All patients were treated with low dose intravenous heparin post-procedure for 24 h as per the departmental protocol. Cases of worsening hemorrhage requiring surgical evacuation were considered significant hemorrhages. Prior surgical exploration and external ventricular drain (EVD) placement were also noted. RESULTS: There were two cases (1.4%) of significant worsening hemorrhage during post-procedure heparin administration. Among 13 patients who underwent craniotomy (for hematoma evacuation or attempted surgical clipping) prior to EVT, there was one (7.7%) case of significant hemorrhage. Among the 60 patients who underwent EVD placement prior to EVT, there was one (1.7%) case of significant hemorrhage. CONCLUSION: Administration of systemic heparinization may be safe during the first 24 h post-EVT of a ruptured intracranial aneurysm in patients without recent craniotomy. Further study in determining the benefit of this protocol in reducing post-embolization thromboembolic complications may be warranted.
INTRODUCTION:Thromboembolic events are the primary complications encountered during endovascular treatment (EVT) of intracranial aneurysms. Intraprocedural heparinization is common during EVT but is less common post-procedure. The safety of heparinization following EVT is unknown, especially for ruptured aneurysms. MATERIALS AND METHODS: The records of 138 consecutive patients at our institution from 1 January 2000 to 30 June 2007 who were treated with EVT for 140 ruptured intracranial aneurysms were reviewed. All patients were treated with low dose intravenous heparin post-procedure for 24 h as per the departmental protocol. Cases of worsening hemorrhage requiring surgical evacuation were considered significant hemorrhages. Prior surgical exploration and external ventricular drain (EVD) placement were also noted. RESULTS: There were two cases (1.4%) of significant worsening hemorrhage during post-procedure heparin administration. Among 13 patients who underwent craniotomy (for hematoma evacuation or attempted surgical clipping) prior to EVT, there was one (7.7%) case of significant hemorrhage. Among the 60 patients who underwent EVD placement prior to EVT, there was one (1.7%) case of significant hemorrhage. CONCLUSION: Administration of systemic heparinization may be safe during the first 24 h post-EVT of a ruptured intracranial aneurysm in patients without recent craniotomy. Further study in determining the benefit of this protocol in reducing post-embolization thromboembolic complications may be warranted.
Authors: Moritz Lenschow; Niklas von Spreckelsen; Sergej Telentschak; Christoph Kabbasch; Roland Goldbrunner; Stefan Grau Journal: Neurosurg Rev Date: 2022-04-29 Impact factor: 2.800
Authors: Michael Müther; Wolfram Schwindt; Rolf Michael Mesters; Jens Minnerup; Paul Stracke; Markus Holling; Heinz Wiendl; Walter Stummer Journal: Neurocrit Care Date: 2022-08-05 Impact factor: 3.532