Introduction: Selection of two treatment modality, clipping by direct surgery or coil embolization by endovascular intervention, is a matter of debate to treat ruptured intracranial aneurysms in the recent neurosurgery. Generally, endovascular intervention is thought to be less invasive than direct surgery. Blood loss due to percutaneous cardiac intervention (PCI) was reported previously, but there has been no study that focuses on blood loss after coil embolization in patients with subarachnoid hemorrhage (SAH). The aim of this study was to elucidate blood loss after coil embolization and compare the loss with that of the patients who received direct surgery.
Methods: From 2010 to 2013, 203 patients with acute SAH who admitted to Kurashiki Central Hospital were retrospectively reviewed. Of these, 152 patients received clipping or coil embolization for a ruptured aneurysm (direct surgery 98, endovascular intervention 54). Patients’ data including age, sex, WFNS grade, bleeding source, red blood cell count, hematocrit, hemoglobin, blood urea nitrogen (BUN), creatinine on admission and after the operation, red blood cell transfusion, and prognosis were collected from medical records.
Results: Coil embolization was performed significantly more in elderly cases (mean 68.3 vs 61.4, P=0.003) and to the posterior circulation aneurysms, than clipping. There was no significant difference in WFNS grade and Fisher CT group on admission, and postoperative symptomatic vasospasm. Hematocrit and hemoglobin on admission were significantly lower in coil embolization; however the changes between pre- and post-treatment did not show the difference between the two treatment modality. On the other hand, significantly greater difference was observed in BUN decline in direct surgery group compared to endovascular intervention (mean 3.59 vs 1.26, P=0.003), and creatinine was significantly elevated in endovascular group (P=0.03). Of 54 patients who received coil embolization, 12 patients (22.2%) received red blood cell transfusion after the procedure. Modified Rankin scale on 3months after the onset was nonsignificant but better in direct surgery group (mean 2.86 vs 2.13, P=0.078).
Conclusions: Significant amounts of blood were lost in the patients who received coil embolization after SAH. Blood count must be checked perioperatively not only during direct surgery but also during endovascular intervention in patients with SAH.
Patient Care: To understand blood loss after coil embolization followed by an appropriate adjust of anemia will improve patient care.
Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of significant blood loss after coil embolization.