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Neurosurgery. 2010 Jul;67(1):73-8; discussion 78-9. doi: 10.1227/01.NEU.0000370937.70207.95.

Hemorrhagic complications related to the stent-remodeled coil embolization of intracranial aneurysms.

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1
Department of Radiology, Research Institute of Radiological Sciences, Yonsei University College of Medicine, Seoul, Korea.

Abstract

OBJECTIVE:

To evaluate the postprocedural hemorrhagic complications associated with stent-remodeled coil embolization of intracranial aneurysms.

METHODS:

From the database of 163 cases of stent-remodeled therapy for wide-neck intracranial aneurysms, patients who showed intracranial hemorrhagic complications on follow-up brain imaging were selected. The initial presentation, antithrombotic medication, hemorrhagic type, location, amount, association with ventriculostomy, symptomatic involvement, and outcome were assessed.

RESULTS:

Ten patients (6.1%) developed intracranial hemorrhagic complications (range; 0-422 days; mean; 56 days). The hemorrhagic complication rate was higher in patients with acute subarachnoid hemorrhage (20%, 6 of 30 patients) than in patients with unruptured aneurysms (3%, 4 of 133 patients). Nine of the 10 patients were on dual-antiplatelet therapy at the time of hemorrhage development. Seven of the hemorrhages developed in patients with ventriculostomies (intraparenchymal, n=4; subdural hematoma, n=3). Three patients who did not receive a ventriculostomy also developed intracranial hemorrhage (n=1) or intraparenchymal hemorrhage (n=2). Hemorrhagic transformation in the recently infarcted brain tissue seemed to be the cause of nonventriculostomy related intraparenchymal hemorrhage. The hemorrhages were accompanied by symptomatic aggravation in 6 of 10 cases, with 5 cases resulting in moribund clinical outcome.

CONCLUSION:

Postprocedural intracranial hemorrhage may be a risk of stent-remodeled therapy while the patient is on dual-antiplatelet medication. Extra caution is warranted especially in patients with acute subarachnoid hemorrhage requiring ventriculostomy or with underlying recent brain infarction.

[Indexed for MEDLINE]

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