Rescue therapy for acute thromboembolic occlusion during endovascular treatment of cerebral aneurysms

Abstract

Background and Purpose:One of the most common complications that occurrs during the treatment of cerebral aneurysm is acute thromboembolic occlusion. With the advent of endovascular devices and techniques, various recanalization methods have been introduced. We report our experience with rescue therapies for acute thromboembolic occlusions during endovascular treatment of cerebral aneurysms.Materials and Methods: From March 2009 to February 2011, acute thromboembolic events occurred in 7 patients among 153 cases of endovascular coil embolization. We performed rescue treatment for these 7 patients using endovascular methods. Our protocol for recanalization includes intra-arterial chemical and/or mechanical thrombolysis. Urokinase, glycoprotein IIb-IIIa inhibitor (Tirofiban) and self-expandable stents were used for recanalization. We assessed the recanalization results with a TICI (Thrombolysis in cerebral infarction) grading system immediately after the rescue therapy, and clinical outcomes were reviewed. Results: Two men and 5 women (age range 49~69, mean age 56 years) were treated with rescue therapy. All 7 patients presented with subarachnoid hemorrhage; intra-arterial chemical thrombolysis was successful in 3, and their TICI grades were 2a (n=3). In the other 4 patients, successful recanalization was achieved with a self-expandable stent, and 3 of them had favorable outcomes as TICI grades were 2b (n=1) or 3 (n=2). Emergency bypass surgery was performed in one patient after a failed endovascular recanalization procedure. Conclusions:With these rescue treatments, we can minimize permanent neurological deficits from thromboembolic complications after endovascular procedures. Stent-assisted revascularization with concomitant administration of IIb-IIIa inhibitors contributed to the achievement of increased recanalization rates.