Stent-Assisted Coiling of Wide-Necked Aneurysms in the Setting of Acute Subarachnoid Hemorrhage

Amenta, Peter S.; Dalyai, Richard; Kung, David; Toporowski, Amy; Chandela, Sid; Hasan, David; Gonzalez, L. Fernando; Dumont, Aaron S.; Tjoumakaris, Stavropoula; Rosenwasser, Robert H.; Maltenfort, Mitchell; Jabbour, Pascal

doi:10.1227/neu.0b013e318246a4b1

Cited by 101 publications

(54 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The technique-related complication rate was 21% (13 of 61), with thromboembolic complications in 9 patients and aneurysm perforations in 4 patients. Amenta et al 1 reported a retrospective study of 65 patients with ruptured wide-necked aneurysms treated with SAC in whom there were 10 (15.38%) major complications associated with bleeding secondary to either antiplatelet thera- py or intraoperative in-stent thrombosis (5 patients each, 7.7%). Three patients (4.6%) suffered a fatal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…1,25,27 Use of the SAC procedure has achieved excellent occlusion of the aneurysms and decreased the rates of angiographic recurrence. 12,27 In this study, follow-up angiographic results (mean 14.8 months) showed that 67.9% of aneurysms were completely occluded, which was improved compared with the immediate postembolization angiographic results (56.9% with complete occlusion).…”

Section: Discussionmentioning

confidence: 99%

“…Most of the previous studies did not routinely administer anticoagulants prior to the procedure, although most patients did receive intraprocedural heparin for SAC performed in the setting of acutely ruptured aneurysms. 1,8,18,22,30 In most patients with ruptured aneurysms, only after several coils had entered the aneurysm would full heparinization take place, with a goal ACT of approximately 250 seconds. 18,30 Chalouhi et al 8 gave patients intraprocedural clopidogrel (600 mg) and a heparin bolus (50 U/kg) after delivery of the first coil.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, stent-assisted coil embolization (SAC) has become a popular option for treatment of aneurysms that are not amenable to endovascular treatment. 1,2,5,12,24 This technique, however, requires that a foreign body (the stent) remain within the artery, thereby requiring anticoagulation or antiplatelet therapy to prevent procedure-related thromboembolic complications. Therefore, neurosurgeons and neurointerventionists have been reluctant to treat ruptured aneurysms with stent assistance because of the potential risk of hemorrhagic complications if patients require additional surgical procedures, as well as thromboembolic complications caused by the stent.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications

Chung¹,

Lim

Suh

et al. 2014

JNS

View full text Add to dashboard Cite

Object. The purpose of this study was to report the authors' experiences in stent-assisted coil embolization (SAC) of ruptured wide-necked aneurysms in the acute period and to evaluate the incidence of and risk factors for periprocedural complications.Methods. A total of 72 patients were recruited for this study between March 2007 and June 2012. All patients met the following criteria: 1) the presence of ruptured intracranial wide-necked saccular aneurysms, and 2) the patient underwent SAC for treatment of those aneurysms within 72 hours of rupture. All of the patients with clinically poor grades or acute hydrocephalus underwent external ventricular drainage (EVD) before SAC. The incidence of and risk factors for periprocedural complications were retrospectively evaluated.Results. Of the 72 patients included in this study, periprocedural complications occurred in 14 (19.4%), including asymptomatic complications in 4 (5.6%) and symptomatic complications in 10 (13.9%); there were symptomatic thromboembolic complications in 5 patients (6.9%), and symptomatic hemorrhagic complications in 5 (6.9%). The authors observed no subacute or delayed thromboembolic complications during the follow-up period of 18.8 months. Use of EVD (OR 1.413, 95% CI 0.088 -2.173; p = 0.046) was the only independent risk factor for periprocedural complications on multivariate logistic regression analysis.Conclusions. The periprocedural complication rate during SAC was 19.4% among 72 patients. Because of the high complication rate, microsurgical clipping or endovascular treatment with another technique (multiple-microcatheter or balloon-assisted technique) may be a more appropriate option for first-line treatment than SAC, especially in patients requiring EVD. (http://thejns.org/doi/abs/10.3171/2014.4.JNS131662) keY WorDS • periprocedural complication • ruptured intracranial aneurysm • stent-assisted coil embolization • wide-necked aneurysm • vascular disorders Abbreviations used in this paper: ACT = activated clotting time; EVD = external ventricular drainage; GOS = Glasgow Outcome Scale; GP = glycoprotein; IPH = intraparenchymal hemorrhage; SAC = stent-assisted coil embolization; SAH = subarachnoid hemorrhage.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications

Chung¹,

Lim

Suh

et al. 2014

JNS

View full text Add to dashboard Cite

show abstract

“…We have previously reported a 2.5% rate of in-stent stenosis in our series. 10 The following factors were tested for as predictors of recanalization: age, sex, ruptured aneurysm status, Hunt and Hess grade, aneurysm location, aneurysm size, previous aneurysm treatment, type of stent, stenting technique, staged treatment, procedural complications, delivery of coils before stent placement, immediate aneurysm occlusion, and follow-up time. In univariate analysis, predictors of recanalization were (1) older age (>65 years; P=0.01), (2) previously coiled aneurysms (P=0.02), (3) larger aneurysms (>10 mm; P<0.001), (4) incompletely occluded aneurysms (P=0.003), (5) Neuroform stent (P=0.1), (6) staged treatment (P=0.1), and (7) Of the 28 aneurysms treated with a telescoping stent technique, 19 had available angiographic follow-up at a mean time point of 16.7 months.…”

Section: Angiographic Outcomementioning

confidence: 99%

Stent-Assisted Coiling of Intracranial Aneurysms

Chalouhi

Jabbour

Singhal

et al. 2013

Stroke

Self Cite

346

View full text Add to dashboard Cite

Background and Purpose-Self-expanding stents are increasingly used for treatment of complex intracranial aneurysms.We assess the safety and the efficacy of intracranial stenting and determine predictors of treatment outcomes. Methods-A total of 508 patients with 552 aneurysms were treated with Neuroform and Enterprise stents between 2006 and 2011 at our institution. A multivariate analysis was conducted to identify predictors of complications, recanalization, and outcome. Results-Of 508 patients, 461 (91%) were treated electively and 47 (9%) in the setting of subarachnoid hemorrhage.Complications occurred in 6.8% of patients. In multivariate analysis, subarachnoid hemorrhage, delivery of coils before stent placement, and carotid terminus/middle cerebral artery aneurysm locations were independent predictors of procedural complications. Angiographic follow-up was available for 87% of patients at a mean of 26 months. The rates of recanalization and retreatment were, respectively, 12% and 6.4%. Older age, previously coiled aneurysms, larger aneurysms, incompletely occluded aneurysms, Neuroform stent, and aneurysm location were predictors of recanalization. Favorable outcomes were seen in 99% of elective patients and 51% of subarachnoid hemorrhage patients. Patient age, ruptured aneurysms, and procedural complications were predictors of outcome. Conclusions-Stent-assisted coiling of intracranial aneurysms is safe, effective, and provides durable aneurysm closure.Higher complication rates and worse outcomes are associated with treatment of ruptured aneurysms. Stent delivery before coil deployment reduces the risk of procedural complications. Staging the procedure may not improve procedural safety. Closed-cell stents are associated with significantly lower recanalization rates. (Stroke. 2013;44:1348-1353.)

show abstract

The Neurointerventional Toolkit

Eboli

Drazin

Alexander

2014

Neurointervention in the Medical Specialties

View full text Add to dashboard Cite

Stent-Assisted Coiling of Wide-Necked Aneurysms in the Setting of Acute Subarachnoid Hemorrhage

Abstract: Our findings suggest that stent-assisted coiling and routine treatment with antiplatelet agents is a viable option in the management of ruptured wide-necked aneurysms.

Cited by 101 publications

References 41 publications

Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications

Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications

Stent-Assisted Coiling of Intracranial Aneurysms

The Neurointerventional Toolkit

Contact Info

Product

Resources

About