Parent artery occlusion
Thy selected antiplatelet medicines according to an official protocol: a combination of 200 mg aspirin, 150 or 300 mg clopidogrel, and 200 mg cilostazol. Systemic heparinization was done after sheath insertion in all cases. One hundred and ten consecutive, ruptured cerebral saccular aneurysms that underwent coiling were analyzed. Procedure-related thrombus formation on DSA and clinical evidence of ischemia and procedure-related stroke on CT were reviewed.
Eighty cases (73%) were medicated with multiple antiplatelet medications, 22 cases (20%) were treated with a single medication and 8 cases (7%) were treated without antiplatelet medication. Thromboembolic complications were reduced in an inverse relationship with the number of antiplatelet medications. Hemorrhagic complications due to antiplatelet medications did not occur. Post-operative symptomatic vasospasm tended to decrease, and outcome also tended to improve in the multiple medications groups. Reduction of thromboembolic complication significantly improved clinical outcome in logistic regression analysis.
Preoperative multiple antiplatelet medication reduced thromboembolic events in coiling during acute stage SAH and improved clinical outcomes 1).