• Thromboembolism during coil embolization of ruptured and unruptured cerebral aneurysm

    Final Number:

    Yasuhiro Kawabata MD; Tomokazu Aoki; Tetsuya Tsukahara; Shunichi Fukuda; Satoru Kawarazaki; Yamashita Kohsuke; Hidenori Miyake

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Thromboembolism is the most important adverse event of neurointervention We retrospectively analyzed the incidence and the outcome of thromboembolism during coiling embolization of saccular cerebral aneurysm.

    Methods: Since 2005, we treated 81 patients with 90 aneurysms, in whom 96 procedures were performed. 20 patients were male, and 61 patients were female. The median age was 65 years (range 38-88). 48 aneurysms were ruptured, and 42 aneurysms were unruptured. In two patients, coil embolization of a ruptured aneurysm and an unruptured aneurysm was performed simultaneously. Retreatment was performed in 8 patients. Dual antiplatelet drugs were administered preoperatively and throughout the early postoperative period in unruptured group.

    Results: Thromboembolic events occurred in 15 procedures (16%), in14 of which thromboemboli were considered to originate from the detached coils. Ozagrel sodium, a thromboxane A2 synthase inhibitor, was immediately administered in 9 patients, and thrombectomy using Penumbra system® was performed in a patient. Major cerebral artery occlusion was observed in 6 patients, in 4 of whom recanalization could be achieved during the procedure (2) and within 24 hours (2). 7 patients remained asymptomatic, and 2 patients had transient ischemic symptoms. 2 patients with ruptured aneurysms died due to causes unrelated to thromboembolism. Permanent procedure-related morbidity was observed in 4 patients (4.1%) exclusively in ruptured group, three of whom had favorable outcome (mRS<=2). The other patient with ruptured anterior communication artery aneurysm was presented with coma and had poor outcome in spite of the treatment. Coil embolization in the acute phase of SAH was likely to be associated with thromboembolic events compared with the elective procedure, but the the difference was not statistically significant (p=0.08, Fisher exact test).

    Conclusions: Our data showed that the incidence and the outcome of thromboembolism during coil embolization of ruptured and unruptured aneurysm can be acceptable.

    Patient Care: Even when thromboembolism occurred during coil embolism of ruptured and unruptured cerebral aneurysms, urgent administration of Ozagrel, a thromboxane A2 synthase inhibitor, or threombectomy using Penumbra® will improve the outcome.

    Learning Objectives: By the conclusion of this session, patients with unrutpured and ruptured cerebral aneurysms can be treated endovasuculary as long as proper preventive methods and urgent recanalization procedures are prepared.


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