Introduction: Concerns have arisen regarding the potential hemorrhagic risks of intraprocedural anticoagulation with unfractionated heparin for balloon and stent-assisted procedures and periprocedural dual antiplatelet therapy for stent-assisted cases for patients having undergone placement of external ventriculostomy.
Methods: This is a retrospective review of patients presenting to a single academic center. All patients underwent EVD placement via twist-drill burrhole within 24 hours of embolization. Individuals underwent CT scan of the head after drain placement and prior to catheterization as well as another within 48 hours of embolization. Post procedure CT scans were reviewed for new or worsened track hemorrhages. Charts were reviewed to identify use of balloon or stent-assisted techniques and those undergoing primary coiling. Additionally, chart reviews identified the presence of new neurologic morbidity attributed to track hemorrhages. Chi-squared tests were used to evaluate outcomes.
Results: One hundred seven patients from 7/2005-4/2014 underwent EVD placement prior to coiling of the associated aneurysm. 91 of these individuals met inclusion criteria (N=91; 85%). Mean age was 55.2 yrs. 64 patients were female (70.3%) and 63 were Caucasian (69.25). 19 patients underwent balloon or stent-assisted procedures (21%; 3 = stent/16 = balloon). 1 patient in the balloon/stent group exhibited new/worse track hemorrhage vs 13 in the primary coil group (5.3% vs. 18.1%; p =0.169) No new/worse track hemorrhage exhibited attributable neurologic morbidity.
Conclusions: Balloon and stent-assisted techniques represent a reasonable treatment option for patients with ruptured aneurysms undergoing embolization following EVD placement for select patients in this limited study where zero patients exhibited new deficits from track hemorrhage. These findings mirror previously reported data.
Patient Care: Improving the knowledge base surrounding risks associated with advanced endovascular techniques will certainly directly influence both timing of procedures as well as procedural techniques. Additionally, such information may me used in patient counseling regarding the potential risks of intervention.
Learning Objectives: By the conclusion of this session participants should be able to 1) describe the relative overall risk of hemorrhage with EVD placement, 2) Compare the relative risk of hemorrhagic complications between primary coiling and adjunct treatments, 3) Apply knowledge of complication risks to clinical practice.
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