Types of Thromboembolic Complications in Coil Embolization for Intracerebral Aneurysms and Management.
10.3340/jkns.2009.46.3.226
- Author:
Hong Ki KIM
1
;
Sung Kyun HWANG
;
Sung Hak KIM
Author Information
1. Department of Neurosurgery, School of Medicine, Ewha Womans University, Seoul, Korea. nshsg@ewha.ac.kr
- Publication Type:Original Article
- Keywords:
Thromboembolism;
Coil embolizatio;
Mechanical obstruction;
Distal embolic stroke;
Stent-induced complication
- MeSH:
Aneurysm;
Angioplasty, Balloon;
Female;
Fibrinolytic Agents;
Humans;
Intracranial Aneurysm;
Male;
Middle Cerebral Artery;
Platelet Aggregation Inhibitors;
Prognosis;
Retrospective Studies;
Stents;
Stroke;
Thromboembolism;
Thrombosis
- From:Journal of Korean Neurosurgical Society
2009;46(3):226-231
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: We describe our clinical experiences and outcomes in patients who had thromboembolic complications occurring during endovascular treatment of intracerebral aneurysms with a review of the literature. The types of thromboembolic complications were divided and the treatment modalities for each type were described. METHODS: Between August 2004 and March 2009 we performed endovascular embolization with Guglielmi detachable coils for 173 patients with 189 cerebral aneurysms, including ruptured and unruptured aneurysms at our hospital. Sixty-eight patients were males and 105 patients were females. The age of patients ranged from 22-82 years (average, 58.8 years). We retrospectively evaluated this group with regard to complication rates and outcomes. The types of thromboembolic complications were classified into the following three categories: mechanical obstruction, distal embolic stroke, and stent-induced complications, which corresponded to types I, II, and III, respectively. A comparison of the clinical results was made for each type of complication. RESULTS: Only eight patients had a thromboembolic complication during or after a procedure (4.6%). Of the eight patients, two had a mechanical obstruction as the causative factor; the other three patients had distal embolic stroke as the causative factor. The remaining three patients had stent-induced complications. In cases of mechanical obstruction, recanalization occurred due to the use of intra-arterial thrombolytic agents in one of two patients. Nevertheless, a poor prognosis was seen. In the cases of stent-induced complications, in one of three patients in whom a thrombus developed following stent insertion, a middle cerebral artery territory infarct developed with a poor prognosis despite the use of wiring and an intra-arterial thrombolytic agent. In the cases of distal embolic stroke, all three patients achieved good results following the use of antiplatelet agents. CONCLUSION: Treatment for thromboemboic complications due to mechanical obstruction and stent-induced complications include antiplatelet and intra-arterial thrombolytic agents; however, this cannot guarantee a sufficient extent of effectiveness. Therefore, active treatments, such as balloon angioplasty, stent insertion, and clot extraction, are helpful.
