Postprocedural Thrombosis following Endovascular Treatment of Intracranial Aneurysm with Flow Diverters or Coiling: A Histologic Study

Larco, Jorge Arturo; Abbasi, Mehdi; Liu, Yang; Dai, Daying; Lanzino, Giuseppe; Savastano, Luis; Cloft, Harry J.; Kallmes, David F.; Kadirvel, R; Brinjikji, Waleed

doi:10.3174/ajnr.a7369

Cited by 6 publications

(9 citation statements)

References 15 publications

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“…Many mediators of the inflammation, such as IL-1 and IL-6, and prothrombotic factors, such as platelet-activating factor (PAF), von Willebrand factor (vWF), and β-thromboglobulin, have been involved in the microthrombus formation following SAH ( 29 – 32 ). Hirashima et al studied the level of PAF in the peripheral blood ( 30 ) and in the jugular vein ( 31 ) of patients with SAH showing a peak at days 5–9, explaining also the crucial role of platelet aggregation in thrombus formation during endovascular treatment of ruptured aneurysms as demonstrated by Larco et al ( 33 ) in their histopathological study.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2023

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BackgroundAlthough 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 methodsWe 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).ResultsThe 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.ConclusionsEndovascular 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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Section: Discussionmentioning

confidence: 97%

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

et al. 2023

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“…Histopathological investigations confirm high expression of platelets at the periphery of thrombi, forming an encapsulating shell-like structure, which likely attenuates the effect of fibrinolytics. (3) Recanalization options would include intravenous or intra-arterial thrombolysis; or aspiration thrombectomy. As seen in this case, navigating past the stent occlusion without damaging or disturbing the existing stent can be technically difficult.…”

Section: Discussionmentioning

confidence: 99%

Hyperacute in-Stent Thrombosis Causing Large Vessel Occlusion after Stent-Assisted Aneurysm Coiling Secondary to Complete Clopidogrel and Prasugrel Resistance: a Case Report

Xian

Morrison

Wong

2022

J Neurol Surg A Cent Eur Neurosurg

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“…IAs often present a challenge for surgical management and are associated with various morbidities, especially for aneurysms with specific features that were intractable to clip ( 4 ). In the acute phase of hemorrhage, endovascular therapy also carries a high risk of thrombosis ( 5 ). Wrapping is a treatment for IAs that cannot be sufficiently treated by endovascular strategies or clipping.…”

Section: Discussionmentioning

confidence: 99%

Clip-reinforced wrapping using the Y-shaped temporalis fascia technique for intracranial aneurysms

Chen

et al. 2022

Front. Surg.

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ObjectivesThis study aims to identify the effectiveness of the clip-reinforced wrapping using the Y-shaped temporalis fascia (CRYST) technique for treating intracranial aneurysms (IAs).MethodsWe retrospectively reviewed five patients with ruptured IAs treated using the CRYST technique from July 2016 to May 2021. Three patients had blood blister-like aneurysms (BBAs) (one with intraoperative rupture), and two had anterior communicating artery (AcoA) aneurysms (one with intraoperative rupture). All patients had intraoperative indocyanine green angiography, and digital subtraction angiography (DSA) was reviewed 10–14 days after surgery. At 1 year postoperatively, three patients (two BBAs and one AcoA aneurysm) underwent DSA and two patients (one BBA and one AcoA aneurysm) underwent computed tomographic angiography (CTA).ResultsTwo aneurysms ruptured intraoperatively during the clipping, and no severe complications occurred. No patients had neurological deficits after surgery, and they had good outcomes. Four DSAs showed no aneurysms and no significant stenosis of the parent artery 10–14 days after surgery. One patient had mild stenosis of the parent artery on DSA 10 days after surgery; the stenosis improved on DSA 1 year after surgery. No other aneurysms recurred, and parent arteries were clear on CTA or DSA 1 year after surgery.ConclusionsCombining our accumulated experience in the work and literature, we described the CRYST technique to treat intractable IAs with specific morphologies and irregular wall structures in our patients. All outcomes and follow-up results were favorable.

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Postprocedural Thrombosis following Endovascular Treatment of Intracranial Aneurysm with Flow Diverters or Coiling: A Histologic Study

Cited by 6 publications

References 15 publications

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

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

Hyperacute in-Stent Thrombosis Causing Large Vessel Occlusion after Stent-Assisted Aneurysm Coiling Secondary to Complete Clopidogrel and Prasugrel Resistance: a Case Report

Clip-reinforced wrapping using the Y-shaped temporalis fascia technique for intracranial aneurysms

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