Mechanically Induced Vasospasm and Postoperative Cerebral Infarction after Coil Embolization of Unruptured Cerebral Aneurysms in Anterior Circulation

We occasionally encounter situations which requires retraction of the guiding system or administration of vasodilatory agents for mechanically induced vasospasm (MVS). However, whether MVS is associated with postoperative cerebral infarction has not been reported. To explore factors associated with MVS and to verify how MVS influences procedure outcomes, we reviewed consecutive cases of unruptured aneurysms in the anterior circulation treated with coil embolization between January 2017 and February 2020. Collected data included patients' clinical characteristics, devices, vessel tortuosity, severity of MVS, diameter of the parent vessel, and procedure duration. Significant MVS was defined as a condition necessitating a pause in the procedure. We also counted postoperative diffusion-weighted imaging (DWI) hyperintense spots (DHS). Parameters associated with MVS and postoperative DHS were investigated by multivariate logistic regression. A total of 103 cases met the eligibility criteria, with significant MVS occurring in 21 cases (20.3%), and postoperative DHS (≥3) confirmed in 30 cases (29.1%). Significant MVS was associated only with larger caliber at the tip of the guiding system compared with the parent vessel (p = 0.001). Postoperative DHS was associated with significant MVS (p = 0.002, OR: 5.313; 95% CI: 1.851–15.254). Significant MVS is a predictor of postoperative cerebral ischemia and occurs in patients with smaller caliber of the parent vessel. In patients with high-risk features for MVS, we should avoid navigating the guiding system forcibly through the narrow parent vessel. In other words, it is crucial to place the large-caliber guiding sheath/catheter proximally and only guide distally the intermediate catheter with better trackability.