Predictors of thromboembolic complications after stent-assisted coiling of acutely ruptured intracranial aneurysms: A retrospective multicenter study

Abstract

BackgroundStent-assisted coiling (SAC) has been reported to safely and effectively treat wide-necked unruptured intracranial aneurysms. However, SAC of acutely ruptured aneurysms is controversial because of perioperative thromboembolic complications. We aimed to investigate the predictors of the thromboembolic complications after SAC of acutely ruptured aneurysms.MethodsWe performed a retrospective multicenter analysis of 110 consecutive patients with ruptured intracranial aneurysms treated with SAC within 72 h of the onset of subarachnoid hemorrhage. Thromboembolic complications were defined as any angiographic filling defects at the aneurysms base or the distal artery during the stent treatment and the new onset of symptomatic ischemia and a new hypo-density in a vascular distribution confirmed by CT scan within 24 h of treatment. These patients were grouped into patients with thromboembolic complications and those without thromboembolic complications. A multivariate logistic regression analysis was performed to identify predictors of thromboembolic complications.ResultsOne hundred and one patients with 101 ruptured aneurysms were included in this study. 9 (8.9%) patients experienced thromboembolic complications. Patients with thromboembolic complications had a higher rate of unfavorable outcomes at discharge (P < 0.001) and at the last follow-up (p = 0.017). Of these patients, four patients presented with intraprocedural thrombus formation, and 5 experienced postprocedural ischemia. There was a trend toward thromboembolic complications in patients with a higher Fisher grade (p = 0.076) and those treated with intravenous tirofiban (p = 0.052). Patients with thromboembolic complications more often presented with poor grade clinical conditions (p = 0.005) and aneurysms with a large dome to neck ratio (p = 0.031). In the multivariate analysis, a worse World Federation World Federation of Neurological Societies (WFNS) grade (OR = 8.241; 95% CI 1.686–40.292; P = 0.009) and a larger dome to neck ratio (OR = 5.385; 95% CI 1.023–28.337; P = 0.047) were independent predictors of thromboembolic complications.ConclusionPatients with thromboembolic complications are more likely to have an unfavorable outcome. A worse clinical condition before the treatment and a larger dome to neck ratio were independent predictors of thromboembolic complications after SAC of acutely ruptured intracranial aneurysms.

Perioperative complications of arteriovenous tirofiban administration versus oral dual antiplatelet therapy for stent‐assisted embolization treated aneurysmal subarachnoid hemorrhage: A retrospective, controlled cohort analysis

“…Furthermore, it has been suggested that wide-necked aneurysms are more amenable to stentassisted embolization. Several studies have suggested that the dometo-neck ratio has an impact on perioperative TEs during stent-assisted embolization of ruptured intracranial aneurysms (Li et al, 2022). Additionally, Liu et al reported that an increase in the dome-to-neck ratio is associated with a higher likelihood of perioperative thromboembolic events during stent-assisted embolization of ruptured intracranial aneurysms, although the association was not significant (Liu et al, 2016).…”

“…However, a multicenter retrospective study suggested that the prevention of perioperative TEs using intravenous tirofiban was less effective than when using a preoperative oral loading dose of DAPT. This could be due to the small sample size, with only 15 cases in the tirofiban group, making the study somewhat subject to error (Li et al., 2022 ). We further analyzed the postoperative 24‐h coagulation indexes and venous blood platelet counts.…”

“…Furthermore, it has been suggested that wide‐necked aneurysms are more amenable to stent‐assisted embolization. Several studies have suggested that the dome‐to‐neck ratio has an impact on perioperative TEs during stent‐assisted embolization of ruptured intracranial aneurysms (Li et al., 2022 ). Additionally, Liu et al.…”