Cargando…

Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review

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 cerebr...

Descripción completa

Detalles Bibliográficos
Autores principales: Golshani, Kiarash, Ferrel, Andrew, Lessne, Mark, Shah, Pratish, Chowdhary, Abhineet, Choulakian, Armen, Alexander, Michael J., Smith, Tony P., Enterline, David S., Zomorodi, Ali R., Britz, Gavin W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424670/
https://www.ncbi.nlm.nih.gov/pubmed/22937484
http://dx.doi.org/10.4103/2152-7806.99174
_version_ 1782241247596904448
author Golshani, Kiarash
Ferrel, Andrew
Lessne, Mark
Shah, Pratish
Chowdhary, Abhineet
Choulakian, Armen
Alexander, Michael J.
Smith, Tony P.
Enterline, David S.
Zomorodi, Ali R.
Britz, Gavin W.
author_facet Golshani, Kiarash
Ferrel, Andrew
Lessne, Mark
Shah, Pratish
Chowdhary, Abhineet
Choulakian, Armen
Alexander, Michael J.
Smith, Tony P.
Enterline, David S.
Zomorodi, Ali R.
Britz, Gavin W.
author_sort Golshani, Kiarash
collection PubMed
description 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.
format Online
Article
Text
id pubmed-3424670
institution National Center for Biotechnology Information
language English
publishDate 2012
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-34246702012-08-30 Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review Golshani, Kiarash Ferrel, Andrew Lessne, Mark Shah, Pratish Chowdhary, Abhineet Choulakian, Armen Alexander, Michael J. Smith, Tony P. Enterline, David S. Zomorodi, Ali R. Britz, Gavin W. Surg Neurol Int Original Article 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. Medknow Publications & Media Pvt Ltd 2012-07-28 /pmc/articles/PMC3424670/ /pubmed/22937484 http://dx.doi.org/10.4103/2152-7806.99174 Text en Copyright: © 2012 Golshani K. http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Original Article
Golshani, Kiarash
Ferrel, 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
title Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review
title_full Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review
title_fullStr Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review
title_full_unstemmed Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review
title_short Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review
title_sort stent-assisted coil emboilization of ruptured intracranial aneurysms: a retrospective multicenter review
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424670/
https://www.ncbi.nlm.nih.gov/pubmed/22937484
http://dx.doi.org/10.4103/2152-7806.99174
work_keys_str_mv AT golshanikiarash stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT ferrelandrew stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT lessnemark stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT shahpratish stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT chowdharyabhineet stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT choulakianarmen stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT alexandermichaelj stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT smithtonyp stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT enterlinedavids stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT zomorodialir stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview
AT britzgavinw stentassistedcoilemboilizationofrupturedintracranialaneurysmsaretrospectivemulticenterreview