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  • Long-term outcomes of endovascular aneurysm treatment with intraoperative thrombus formation

    Final Number:

    Isaac Josh Abecassis; Ryan Morton MD; Cory Kelly BS; Basavaraj Ghodke MD; Danial K. Hallam MD, MSc; Louis J. Kim MD; Michael Robert Levitt MD

    Study Design:

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: Endovascular treatment of intracranial aneurysms can be complicated by thrombus formation, requiring administration of intra-arterial (IA) abciximab, a glycoprotein IIb/IIIa inhibitor. While the safety of this practice has been well established, few studies have examined the long-term angiographic outcomes.

    Methods: Single institution, retrospective review of all endovascular interventions for intracranial aneurysm treatment, over a 4-year period.

    Results: A total of 198 aneurysms were treated with endovascular techniques. Balloon assisted coiling (BAC) was used in 70 (35%) of cases, stent assisted coiling (SAC) in 32 (16%) of cases, primary coiling in 59 (29%), and flow diversion in 37 (19%). Thirty-two patients developed intraoperative thrombus treated with IA abiciximab (16%). Thrombus formed during BAC in 15/70 cases (21%) (p=0.159), SAC in 3/32 cases (9%) (p=0.307), and primary coiling in 14/59 (24%) (p=0.017). Gender, age, aneurysm location and rupture status were not statistically significant risk factors for development of intraoperative thrombus. Smoking status was related to thrombus formation; 17/32 (53%) patients in the thrombus group were active smokers compared to 49/166 (30%) in the control cohort (p=0.013). In the thrombus group, immediate Raymond-Roy Scale (RRS) 1 results were seen in 73% (n=23), while 27% (n=9) achieved RRS 2. Of these 9 patients with residual aneurysm, 8 had long term follow-up. Five of the 8 (63%) spontaneously resolved to RRS 1, while 3 (37%) aneurysm remnants persisted during follow-up. Of the 23 patients with immediate RRS 1, 15 (65%) had long term follow up, and only 1 (6.67%) developed aneurysm recurrence.

    Conclusions: Primary coiling and smoking status are predictors for intraoperative thrombus formation necessitating abiciximab therapy. Long-term aneurysm residual is rare despite abciximab treatment.

    Patient Care: Our research will identify risk factors for thrombus formation as well as aneurysm recanalization when intra-arterial abiciximab is used.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) recognize the frequency of intra-procedural thrombus formation during endovascular treatment of aneurysms, 2) identify risk factors for thrombus formation, and 3) understanding strategies for treating thrombus.


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