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coiling_complications

Coiling complications

Parent artery occlusion

Coil migration either during the procedure or after coil embolization.

Intraprocedural aneurysm rupture.


The most uncontrollable complication during coil embolization of a ruptured intracranial aneurysm is thromboembolic ischemia.

Shimamura et al. analyzed whether thromboembolism could be reduced by using preoperative antiplatelet medications for acute subarachnoid hemorrhage in multicenter fashion.

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).

References

1)
Shimamura N, Naraoka M, Matsuda N, Katayama K, Kakuta K, Katagai T, Fujiwara N, Hasegawa S, Ohkuma H. Use of preprocedural, multiple antiplatelet medications for coil embolization of ruptured cerebral aneurysm in the acute stage improved clinical outcome and reduced thromboembolic complications without hemorrhagic complications. World Neurosurg. 2019 Oct 8. pii: S1878-8750(19)32593-8. doi: 10.1016/j.wneu.2019.09.149. [Epub ahead of print] PubMed PMID: 31604135.
coiling_complications.txt · Last modified: 2019/10/12 19:40 by administrador