Timing of complications during and after elective endovascular intracranial aneurysm coiling

Kameda-Smith, Michelle; Klurfan, Paula; Adel, Brian A. van; Larrazabal, Ramiro; Farrokhyar, Forough; Bennardo, Michael; Gunnarsson, Þorsteinn

doi:10.1136/neurintsurg-2017-013110

Cited by 17 publications

(6 citation statements)

References 16 publications

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“…Early experience with eCLIPs provided a learning curve and limited the recommendation to implant the eCLIPs in BT and CT aneurysms only 7 20. Procedural time, as well as procedural complexity, has demonstrated a strong association with the occurrence of procedure related complications 21 22. In this small series, it did not result in more safety events compared with other recent studies14 17–19; nevertheless, shortening total procedure times is an important objective.…”

Section: Discussionmentioning

confidence: 78%

Safety and efficacy of the eCLIPs bifurcation remodelling system for the treatment of wide necked bifurcation aneurysms: 1 year results from the European eCLIPs Safety, Feasibility, and Efficacy Study (EESIS)

Vries

Aquarius

Sørensen

et al. 2022

J NeuroIntervent Surg

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BackgroundThe eCLIPs bifurcation remodelling system is a non-circumferential implant that bridges the neck from outside of a bifurcation aneurysm. The goal of the multicenter, post-marketing European eCLIPs Safety, FeasIbility, and Efficacy Study (EESIS), was to present the efficacy and safety results of the eCLIPs device after 365 days of follow-up.MethodsAll patients were to receive an eCLIPs in conjunction with coils. The study was conducted according to good clinical practices and included independent adjudication of safety and efficacy outcomes.ResultsTwenty patients were enrolled at four European centers. Mean age was 60 years (range 41–74) and aneurysms were located at the basilar tip (n=19) and carotid tip (n=1). Average aneurysm dome height was 6.0 mm (range 2.0–15.0). Mean neck length was 5.1 mm (range 2.6–8.5). The technical success rate was 90% (18 of 20). No major territorial strokes or deaths occurred between the index procedure and after 365 days of follow-up. Complete occlusion was achieved in 60% of patients (12 of 20 patients) and 67% of patients with an eCLIPs device (12 of 18) after 365 days of follow-up. Adequate occlusion (complete occlusion and neck remnant) was achieved in 80% of patients (16 of 20 patients) and 89% of patients with an eCLIPs device (16 of 18 patients) after 365 days of follow-up.ConclusionIn this small series, treatment with eCLIPs was feasible, safe, and efficacious, considering the challenging nature of the aneurysms.Trial registration numberClinicalTrials.gov NCT02607501.

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Section: Discussionmentioning

confidence: 78%

Safety and efficacy of the eCLIPs bifurcation remodelling system for the treatment of wide necked bifurcation aneurysms: 1 year results from the European eCLIPs Safety, Feasibility, and Efficacy Study (EESIS)

Vries

Aquarius

Sørensen

et al. 2022

J NeuroIntervent Surg

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“…Furthermore, our results were similar after a 30-day washout period that ensured that only new ischemic stroke events were captured in the analysis. Fourth, while we did not obtain information on aneurysm treatment procedures such as clipping or endovascular coiling; this likely did not influence our findings particularly because these procedures tend to increase the risk of stroke intraor perioperatively, and not long-term after the index SAH [32,33]. Information on medications often used for secondary stroke prevention such as antithrombotic, lipid lowering, and antihypertensive therapy were not available.…”

Section: Discussionmentioning

confidence: 98%

Long-Term Risk of Ischemic Stroke among Elderly Survivors of Non-Traumatic Subarachnoid Hemorrhage

et al. 2021

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Introduction: Non-traumatic subarachnoid hemorrhage (SAH) is associated with poor long-term functional outcomes, but the risk of ischemic stroke among SAH survivors is poorly understood. Objectives: The aim of this study was to evaluate the risk of ischemic stroke among survivors of SAH. Methods: We performed a retrospective cohort study using claims data from Medicare beneficiaries from 2008 to 2015. The exposure was a diagnosis of SAH, while the outcome was an acute ischemic stroke, both identified using previously validated ICD-9-CM diagnosis codes. We used Cox regression analysis adjusting for demographics and stroke risk factors to evaluate the association between SAH and long-term risk of ischemic stroke. Results: Among 1.7 million Medicare beneficiaries, 912 were hospitalized with non-traumatic SAH. During a median follow-up of 5.2 years (IQR, 2.7–6.7), the cumulative incidence of ischemic stroke was 22 per 1,000 patients per year among patients with SAH, and 7 per 1,000 patients per year in those without SAH. In adjusted Cox models, SAH was associated with an increased risk of ischemic stroke (HR, 2.0; 95% confidence interval, 1.4–2.8) as compared to beneficiaries without SAH. Similar results were obtained in sensitivity analyses, when treating death as a competing risk (sub HR, 3.0; 95% CI, 2.8–3.3) and after excluding ischemic stroke within 30 days of SAH discharge (HR, 1.5; 95% CI, 1.1–2.3). Conclusions: In a large, heterogeneous national cohort of elderly patients, survivors of SAH had double the long-term risk of ischemic stroke. SAH survivors should be closely monitored and risk stratified for ischemic stroke.

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“…Critical care units are substantially more expensive than other hospital units, and their direct costs are rising [15,16]. Complications of EVT of UIAs are known but rare, making their indirect costs challenging to measure [17][18][19][20][21][22]. Hospital charges for EVT of UIAs often exceed those for surgical clipping [17].…”

Section: Discussionmentioning

confidence: 99%

“…Half of the complications that occurred <4 hours after intervention required treatment or resulted in permanent deficits, whereas those that occurred >12 hours after intervention were discharged home without deficits [21]. Furthermore, others have reported that 88% of complications occur within 24 hours of intervention [22]. In our study, the mean NCCU LOS was 1.07 days, and the admission to NCCU likely would not have hastened the detection of, reduced the morbidity associated with, or prevented the post-procedure complications.…”

Section: Discussionmentioning

confidence: 99%

Elective Endovascular Treatment of Unruptured Intracranial Aneurysms

Krueger¹,

Farhat²

2022

Cureus

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BackgroundElective endovascular treatment (EVT) of unruptured intracranial aneurysms (UIA) is a commonly used treatment modality. However, the appropriate post-procedure management is not well-defined. MethodsThis was a single-center, retrospective review of all adults undergoing EVT of UIA performed between January 1, 2010, and March 31, 2020. Patients with any current intracranial hemorrhage or clinical symptoms severe enough to warrant emergent intervention were excluded. ResultsSixty-seven UIA were treated on 58 patients. The mean dome diameter was 6.6 mm (2-20, ±3.9), the most common parent vessel was the internal carotid artery (43.2%, 29/67), and sole flow diverter stents were the most common device used (46.2%, 31/67). Post-treatment, 43.2% (29/67) patients went to the neurocritical care unit (NCCU). The mean NCCU length of stay (LOS) was 1.07 days (range 1-4, ±0.5), and 96.6% (28/29) only spent one day in the NCCU.There were no (0%, 0/67) anesthesia-related procedural complications. One (1.5%, 1/67) intra-procedural complication was an aneurysm rupture during attempted coiling. There were five (7.4%, 5/67) postprocedural complications: two (3.0%, 2/67) groin hematomas, two (3.0%, 2/67) permanent neurologic events (left lower extremity hypoesthesia and left upper extremity hemiparesis), and one (1.5%, 1/67) temporary neurologic event (aphasia). Post-procedural complications were associated with longer hospital LOS (p=0.02), but not with longer NCCU LOS. No acute management changes occurred for the five patients that developed post-procedural complications. There were no (0%, 0/67) 30-day readmissions. ConclusionThe overall incidence of post-procedure complications was low. In the future, a possible viable way to reduce hospital costs may involve utilizing a hospital unit that could closely monitor patients but only for a short period of time post-procedure.

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Timing of complications during and after elective endovascular intracranial aneurysm coiling

Cited by 17 publications

References 16 publications

Safety and efficacy of the eCLIPs bifurcation remodelling system for the treatment of wide necked bifurcation aneurysms: 1 year results from the European eCLIPs Safety, Feasibility, and Efficacy Study (EESIS)

Safety and efficacy of the eCLIPs bifurcation remodelling system for the treatment of wide necked bifurcation aneurysms: 1 year results from the European eCLIPs Safety, Feasibility, and Efficacy Study (EESIS)

Long-Term Risk of Ischemic Stroke among Elderly Survivors of Non-Traumatic Subarachnoid Hemorrhage

Elective Endovascular Treatment of Unruptured Intracranial Aneurysms

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