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Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms

BACKGROUND: Although endovascular treatment of ruptured intracranial aneurysms is well-established, some critical issues have not yet been clarified, such as the effects of timing on safety and effectiveness of the procedure. The aim of our study was to analyze the incidence of intra-procedural comp...

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Autores principales: Gaudino, Chiara, Navone, Stefania Elena, Da Ros, Valerio, Guarnaccia, Laura, Marfia, Giovanni, Pantano, Patrizia, Peschillo, Simone, Triulzi, Fabio Maria, Biraschi, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9874677/
https://www.ncbi.nlm.nih.gov/pubmed/36712444
http://dx.doi.org/10.3389/fneur.2022.1096651
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author Gaudino, Chiara
Navone, Stefania Elena
Da Ros, Valerio
Guarnaccia, Laura
Marfia, Giovanni
Pantano, Patrizia
Peschillo, Simone
Triulzi, Fabio Maria
Biraschi, Francesco
author_facet Gaudino, Chiara
Navone, Stefania Elena
Da Ros, Valerio
Guarnaccia, Laura
Marfia, Giovanni
Pantano, Patrizia
Peschillo, Simone
Triulzi, Fabio Maria
Biraschi, Francesco
author_sort Gaudino, Chiara
collection PubMed
description BACKGROUND: Although endovascular treatment of ruptured intracranial aneurysms is well-established, some critical issues have not yet been clarified, such as the effects of timing on safety and effectiveness of the procedure. The aim of our study was to analyze the incidence of intra-procedural complications according to the timing of treatment, as they can affect morbidity and mortality. MATERIALS AND METHODS: We retrospectively analyzed all patients who underwent endovascular treatment for ruptured intracranial aneurysms at three high flow center. For all patients, imaging and clinical data, aneurysm's type, mean dimension and different treatment techniques were analyzed. Intra-procedural complications were defined as thrombus formation at the aneurysm's neck, thromboembolic events, and rupture of the aneurysm. Patients were divided into three groups according to time between subarachnoid hemorrhage and treatment (<12 h hyper-early, 12–36 h early, and >36 h delayed). RESULTS: The final study population included 215 patients. In total, 84 patients (39%) underwent hyper-early, 104 (48%) early, and 27 (13%) delayed endovascular treatment. Overall, 69% of the patients were treated with simple coiling, 23% with balloon-assisted coiling, 1% with stent-assisted coiling, 3% with a flow-diverter stent, 3% with an intrasaccular flow disruptor device, and 0.5% with parent vessel occlusion. Delayed endovascular treatment was associated with an increased risk of total intra-procedural complications compared to both hyper-early (p = 0.009) and early (p = 0.004) treatments with a rate of complications of 56% (vs. 29% in hyper-early and 26% in early treated group—p = 0.011 and p = 0.008). The delayed treatment group showed a higher rate of thrombus formation and thromboembolic events. The increased risk of total intra-procedural complications in delayed treatment was confirmed, also considering only the patients treated with simple coiling and balloon-assisted coiling (p = 0.005 and p = 0.003, respectively, compared to hyper-early and early group) with a rate of complications of 62% (vs. 28% in hyper-early and 26% in early treatments—p = 0.007 and p = 0.003). Also in this subpopulation, delayed treated patients showed a higher incidence of thrombus formation and thromboembolic events. CONCLUSIONS: Endovascular treatment of ruptured intracranial aneurysms more than 36 h after SAH seems to be associated with a higher risk of intra-procedural complications, especially thrombotic and thromboembolic events.
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spelling pubmed-98746772023-01-26 Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms Gaudino, Chiara Navone, Stefania Elena Da Ros, Valerio Guarnaccia, Laura Marfia, Giovanni Pantano, Patrizia Peschillo, Simone Triulzi, Fabio Maria Biraschi, Francesco Front Neurol Neurology BACKGROUND: Although endovascular treatment of ruptured intracranial aneurysms is well-established, some critical issues have not yet been clarified, such as the effects of timing on safety and effectiveness of the procedure. The aim of our study was to analyze the incidence of intra-procedural complications according to the timing of treatment, as they can affect morbidity and mortality. MATERIALS AND METHODS: We retrospectively analyzed all patients who underwent endovascular treatment for ruptured intracranial aneurysms at three high flow center. For all patients, imaging and clinical data, aneurysm's type, mean dimension and different treatment techniques were analyzed. Intra-procedural complications were defined as thrombus formation at the aneurysm's neck, thromboembolic events, and rupture of the aneurysm. Patients were divided into three groups according to time between subarachnoid hemorrhage and treatment (<12 h hyper-early, 12–36 h early, and >36 h delayed). RESULTS: The final study population included 215 patients. In total, 84 patients (39%) underwent hyper-early, 104 (48%) early, and 27 (13%) delayed endovascular treatment. Overall, 69% of the patients were treated with simple coiling, 23% with balloon-assisted coiling, 1% with stent-assisted coiling, 3% with a flow-diverter stent, 3% with an intrasaccular flow disruptor device, and 0.5% with parent vessel occlusion. Delayed endovascular treatment was associated with an increased risk of total intra-procedural complications compared to both hyper-early (p = 0.009) and early (p = 0.004) treatments with a rate of complications of 56% (vs. 29% in hyper-early and 26% in early treated group—p = 0.011 and p = 0.008). The delayed treatment group showed a higher rate of thrombus formation and thromboembolic events. The increased risk of total intra-procedural complications in delayed treatment was confirmed, also considering only the patients treated with simple coiling and balloon-assisted coiling (p = 0.005 and p = 0.003, respectively, compared to hyper-early and early group) with a rate of complications of 62% (vs. 28% in hyper-early and 26% in early treatments—p = 0.007 and p = 0.003). Also in this subpopulation, delayed treated patients showed a higher incidence of thrombus formation and thromboembolic events. CONCLUSIONS: Endovascular treatment of ruptured intracranial aneurysms more than 36 h after SAH seems to be associated with a higher risk of intra-procedural complications, especially thrombotic and thromboembolic events. Frontiers Media S.A. 2023-01-11 /pmc/articles/PMC9874677/ /pubmed/36712444 http://dx.doi.org/10.3389/fneur.2022.1096651 Text en Copyright © 2023 Gaudino, Navone, Da Ros, Guarnaccia, Marfia, Pantano, Peschillo, Triulzi and Biraschi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Gaudino, Chiara
Navone, Stefania Elena
Da Ros, Valerio
Guarnaccia, Laura
Marfia, Giovanni
Pantano, Patrizia
Peschillo, Simone
Triulzi, Fabio Maria
Biraschi, Francesco
Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms
title Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms
title_full Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms
title_fullStr Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms
title_full_unstemmed Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms
title_short Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms
title_sort incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9874677/
https://www.ncbi.nlm.nih.gov/pubmed/36712444
http://dx.doi.org/10.3389/fneur.2022.1096651
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