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Hemorrhagic complications related to the stent-remodeled coil embolization of intracranial aneurysms.

Authors
 Dong Joon Kim  ;  Sang Hyun Suh  ;  Byung Moon Kim  ;  Dong Ik Kim  ;  Seung Kon Huh  ;  Jae Whan Lee 
Citation
 NEUROSURGERY, Vol.67(1) : 73-9, 2010 
Journal Title
 NEUROSURGERY 
ISSN
 0148-396X 
Issue Date
2010
MeSH
Adult ; Aged ; Angioplasty/adverse effects* ; Angioplasty/instrumentation ; Cerebral Hemorrhage/etiology* ; Cerebral Hemorrhage/pathology ; Cerebral Hemorrhage/physiopathology ; Embolization, Therapeutic/adverse effects* ; Embolization, Therapeutic/instrumentation ; Female ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/pathology ; Intracranial Aneurysm/therapy* ; Male ; Middle Aged ; Postoperative Complications/etiology* ; Postoperative Complications/pathology ; Postoperative Complications/physiopathology ; Radiography ; Stents/adverse effects* ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/pathology ; Subarachnoid Hemorrhage/therapy
Abstract
OBJECTIVE: To evaluate the postprocedural hemorrhagic complications associated with stent-remodeled coil embolization of intracranial aneurysms. METHODS: From the database of 163 cases of stent-remodeled therapy for wide-neck intracranial aneurysms, patients who showed intracranial hemorrhagic complications on follow-up brain imaging were selected. The initial presentation, antithrombotic medication, hemorrhagic type, location, amount, association with ventriculostomy, symptomatic involvement, and outcome were assessed. RESULTS: Ten patients (6.1%) developed intracranial hemorrhagic complications (range; 0-422 days; mean; 56 days). The hemorrhagic complication rate was higher in patients with acute subarachnoid hemorrhage (20%, 6 of 30 patients) than in patients with unruptured aneurysms (3%, 4 of 133 patients). Nine of the 10 patients were on dual-antiplatelet therapy at the time of hemorrhage development. Seven of the hemorrhages developed in patients with ventriculostomies (intraparenchymal, n=4; subdural hematoma, n=3). Three patients who did not receive a ventriculostomy also developed intracranial hemorrhage (n=1) or intraparenchymal hemorrhage (n=2). Hemorrhagic transformation in the recently infarcted brain tissue seemed to be the cause of nonventriculostomy related intraparenchymal hemorrhage. The hemorrhages were accompanied by symptomatic aggravation in 6 of 10 cases, with 5 cases resulting in moribund clinical outcome. CONCLUSION: Postprocedural intracranial hemorrhage may be a risk of stent-remodeled therapy while the patient is on dual-antiplatelet medication. Extra caution is warranted especially in patients with acute subarachnoid hemorrhage requiring ventriculostomy or with underlying recent brain infarction.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00006123-201007000-00011&LSLINK=80&D=ovft
DOI
10.1227/01.NEU.0000370937.70207.95
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Lee, Jae Whan(이재환)
Huh, Seung Kon(허승곤)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/101261
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