Hemorrhagic Complications Associated with Ventriculostomy in Patients Undergoing Endovascular Treatment for Intracranial Aneurysms: A Single-Center Experience

Leschke, Jack; Lozen, Andrew; Kaushal, Mayank; Oni-Orisan, Akinwunmi; Noufal, Mazen; Zaidat, Osama O.; Pollock, Glen; Mueller, Wade

doi:10.1007/s12028-016-0350-y

Cited by 14 publications

(5 citation statements)

References 34 publications

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“…Periprocedural heparin administration had no effect on the rate of VS-ICH, consistent with the largely homogeneous results of previous studies [ 2 , 9 , 14 , 15 , 22 ]. Conflicting results may be explained by different time intervals between ventriculostomy and heparinization [ 8 ].…”

Section: Discussionsupporting

confidence: 91%

“…In this regard, the primary objective of our study was to assess the risk of VS-ICH between endovascular and surgical treatment, as this is frequently debated in our clinical practice. While previous reports found no effect of VS-ICH on clinical outcome [ 3 , 8 , 15 , 20 ], we chose not to analyze clinical outcome in our study because we do not believe that, in the context of a retrospective study, a meaningful correlation can be drawn between these largely minor hemorrhages and the overall clinical outcome in patients often severely affected by the subarachnoid hemorrhage. Regarding acute hemorrhage-related changes in clinical status, clinical evaluation was limited since most patients were sedated at the time of VS-ICH; however, no new oculomotor dysfunction was observed in any of the patients with VS-ICH in our study cohort.…”

Section: Discussionmentioning

confidence: 99%

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Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms

et al. 2022

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Endovascular therapy of ruptured aneurysms is regularly accompanied by periprocedural heparinization and requires the use of periprocedural antiplatelets in more complex cases. This raises concerns regarding increased bleeding risks in the case of frequently required ventriculostomy. The aim of this study was to analyze risk factors for ventriculostomy-related intracranial hemorrhages (VS-ICH) in endovascular or surgical treatment of ruptured aneurysms with a focus on antithrombotic therapy. In this retrospective analysis, we included patients admitted to our institution over a 12-year period who had received at least one ventriculostomy due to subarachnoid hemorrhage-related hydrocephalus. Patients were dichotomized into an endovascular and surgical group and rates of VS-ICH were compared. Risk factors for VS-ICH were assessed in uni- and multivariate analyses. A total of 606 ventriculostomies were performed in 328 patients. Within the endovascular group, antiplatelet therapy was used in 44.8% of cases. The overall rate of ventriculostomy-related intracranial hemorrhage was 13.1%. Endovascular treatment was associated with a higher rate of VS-ICH compared to surgical treatment (p = 0.011), but not in cases without antiplatelet therapy (p = 0.166). Application of any antiplatelet therapy (odds ratio, 2.647 [95% confidence interval, 1.141–6.143]) and number of ventriculostomies (odds ratio, 2.513 [95% confidence interval, 1.859–3.395]) were independent predictors of ventriculostomy-related hemorrhages. Our findings indicate an increased risk of VS-ICH in the endovascular group if administration of antiplatelets was required. While this aspect has to be included into treatment decision-making, it must be weighed against the benefits of endovascular techniques.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms

et al. 2022

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“…Another concern is the occurrence of EVD-related hemorrhagic complications in endovascular-treated patients. Most of the recent literature supports the safety of EVD placement in the peri-endovascular treatment period [ 121 ]. In a recent meta-analysis of 13 studies evaluating 516 patients with antiplatelet therapy, and 647 patients without antiplatelet therapy, patients receiving ventriculostomy and antiplatelet therapy during endovascular treatment of acutely ruptured intracranial aneurysms increases the risk of EVD-related hemorrhages (20.9% vs. 9%), although most of them are small and asymptomatic [ 122 ].…”

Section: Endoscopic Ivh Removalmentioning

confidence: 99%

The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Kuo

Huang

2021

IJMS

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Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) and reportedly contributes to poor neurological outcomes. In this review, we summarize the molecular and cellular mechanisms involved in the pathogenesis of hydrocephalus following aSAH and summarize its treatment strategies. Various mechanisms have been implicated for the development of chronic hydrocephalus following aSAH, including alterations in cerebral spinal fluid (CSF) dynamics, obstruction of the arachnoid granulations by blood products, and adhesions within the ventricular system. Regarding molecular mechanisms that cause chronic hydrocephalus following aSAH, we carried out an extensive review of animal studies and clinical trials about the transforming growth factor-β/SMAD signaling pathway, upregulation of tenascin-C, inflammation-dependent hypersecretion of CSF, systemic inflammatory response syndrome, and immune dysregulation. To identify the ideal treatment strategy, we discuss the predictive factors of shunt-dependent hydrocephalus between surgical clipping and endovascular coiling groups. The efficacy and safety of other surgical interventions including the endoscopic removal of an intraventricular hemorrhage, placement of an external ventricular drain, the use of intraventricular or cisternal fibrinolysis, and an endoscopic third ventriculostomy on shunt dependency following aSAH were also assessed. However, the optimal treatment is still controversial, and it necessitates further investigations. A better understanding of the pathogenesis of acute and chronic hydrocephalus following aSAH would facilitate the development of treatments and improve the outcome.

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“…4 The main causes of morbidity and mortality are thromboembolisms, intraprocedural aneurysm ruptures, and postprocedural aneurysmal reruptures. 5 Among these complications, postprocedural aneurysmal reruptures are often fatal or disabling. 6 Reruptures can be divided into early and late types based on the timing of the postprocedural aneurysmal rerupture.…”

Section: Introductionmentioning

confidence: 99%

Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review

Guo

Zhao

et al. 2017

Interv Neuroradiol

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Acute rerupture after coil embolization is defined as rerupture within three days after treatment; its prognosis is worse than that of rebleeding at other time periods. However, to date, little is known about complications during the acute phase. Therefore, we used the PubMed database to perform a review of acute rerupture after coil embolization of ruptured intracranial saccular aneurysms and increase our understanding. After reviewing the complications, we found that the cause of acute rerupture is unclear, but the following risk factors are involved: incomplete occlusion of the initial aneurysm, the presence of a hematoma adjacent to a ruptured aneurysm, an aneurysmal outpouching, poor Hunt-Hess grade at the time of treatment, and the location of the aneurysm in an anterior communicating artery. In addition, intraoperative rupture is a non-negligible cause. Acute rerupture after coil embolization mainly occurs within the first 24 hours after the procedure. Brain computed tomography is the gold standard for diagnosing acute rebleeding of a coiled aneurysm. For acute rerupture after coil embolization, prevention is critical, and complete occlusion of the aneurysm in the first session is the best protection against acute rebleeding. In addition, a restricted postembolization anticoagulation strategy is recommended for patients with high-risk aneurysms. For patients with an adjacent hematoma, surgical clipping is recommended. Most patients present no changes immediately after acute rebleeding because of their poor condition. However, surgical or endovascular treatments can be attempted if the patient is in an acceptable condition. Even so, the outcomes are typically unsatisfactory.

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Hemorrhagic Complications Associated with Ventriculostomy in Patients Undergoing Endovascular Treatment for Intracranial Aneurysms: A Single-Center Experience

Abstract: Our results, demonstrating no significant risk factor related to EVD-associated hemorrhage rates, support the safety of EVD placement in the peri-endovascular treatment period.

Cited by 14 publications

References 34 publications

Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms

Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms

The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review

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