Frequency of thromboembolic events associated with endovascular aneurysm treatment: retrospective case series

Abstract

Object There is little evidence addressing whether procedures requiring adjunctive devices lead to an increased frequency of thromboembolic complications. The authors report their experience with 155 aneurysms treated with and without adjunctive devices. Methods The authors retrospectively reviewed their last 155 aneurysm coil placement procedures. The patients' records were reviewed for the following phenomena: 1) evidence of procedure-related thrombus formation; 2) clinical evidence of stroke; and 3) the presence of acute ischemia in the treated vascular territory on diffusion-weighted (DW) imaging. Results Of the 155 aneurysms treated in 132 patients, 66 were treated with coils only, 45 had stent-assisted coil placement, 33 underwent balloon remodeling, and in 11 stents were placed after balloon remodeling. Small DW imaging abnormalities were present in the treated vascular territory in 24% of cases (37 lesions). Specifically, 21 (32%) of 66 lesions in the coil-treated group, 6 (13%) of 45 in the stent-assisted coil treatment group, 8 (24%) of 33 in the balloon remodeling group, and 2 (18%) of 11 in the balloon and stent group showed DW imaging positivity. Furthermore, 25 (68%) of the 37 cases that were positive on DW imaging occurred in patients presenting with subarachnoid hemorrhage (SAH). Clinically evident stroke or transient ischemic attack was present in 10 (27%) of 37 cases, with 70% occurring in patients presenting with SAH. Conclusions Use of adjunctive devices in treating aneurysms does not appear to increase the frequency of embolic or ischemic events. The presence of DW imaging abnormalities and clinically evident stroke was actually less frequent when adjunctive devices were used and in electively treated cases. This was probably related to perioperative antiplatelet medical management.

Stent-Assisted Coiling in Endovascular Treatment of 500 Consecutive Cerebral Aneurysms with Long-Term Follow-Up

“…We did not have a control group of coiling without stent assistance in this study; however, previous comparative studies have shown no increase in the frequency of thromboembolic events with the adjunctive use of these devices. 13,18,19 Recently, long-term safety and durability of stent-assisted coiling with Neuroform and Enterprise stents have been investigated. [6][7][8][9][10][11][12][13] We previously reported our preliminary experience with Solo and Wingspan stents, including the immediate and midterm follow-ups.…”

Bailout Stent Deployment during Coil Embolization of Intracranial Aneurysms

“…2 Prevalence of the thromboembolic complication is known to range from 1.0% to 28%. [2][3][4][5][6] A protruded coil loop in the parent artery is one of the significant sources of thrombus formation. [7][8][9] The removal of the detached protruding coil loop by using a snare may be the best solution; however, this may be technically difficult and potentially hazardous, with risks of vessel perforation and malpositioning of other coil loops.…”

Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes

“…[4][5][6][7][8] Prior studies have reported that stent-coiling may result in less aneurysm recanalization over time but more complications-both intraprocedurally and in a delayed fashion-than coiling alone. [9][10][11][12][13] A recent large, single-institution, retrospective series described higher morbidity and mortality rates associated with the stent-coiling technique as compared with coiling either with or without balloon assistance. 14 Given that prospective data on stent-coiling are limited, we analyzed data from the prospective, randomized, multicenter Matrix and Platinum Science (MAPS) Trial (NCT00396981, www.…”