J Cerebrovasc Endovasc Neurosurg.  2017 Sep;19(3):162-170. 10.7461/jcen.2017.19.3.162.

Procedure-related Complications during Endovascular Treatment of Intracranial Saccular Aneurysms

• Ahn JM
• Oh JS
• Yoon SM
• Shim JH
• Oh HJ
• Bae HG

• KMID: 2393498
• DOI: http://doi.org/10.7461/jcen.2017.19.3.162

Abstract

OBJECTIVE
We evaluate the rates and outcomes of major procedure-related complications during coiling.
MATERIALS AND METHODS
Between 2007 and 2015, 436 intracranial saccular aneurysms were treated. Complications are categorized as three types: intraprocedural aneurysm rupture (IAR), thromboembolism (TE), and post-procedural early rebleeding (PER). And we evaluated the risk factors of procedure related complications by multivariate analysis.
RESULTS
Complications occurred in 61 aneurysms (14%). The overall incidence of complications in subarachnoid hemorrhage (SAH) was significantly higher than in unruptured intracranial aneurysm (UIA) (20% vs. 6%). The incidence of IAR and TE were higher in SAH than in UIA (IAR 12% vs. 4%, TE 7% vs. 3%, p < 0.05). Five PER occurred only in SAH. In 34 UIA which were treated with balloon-assisted coiling (BAC), all these patients had good recovery despite 3 patients had the IAR. The incidence of IAR and TE were not different between BAC and non-BAC groups (p > 0.05). All 7 patients who had IAR during BAC had good recovery. In multiple logistic regression analysis, female gender, SAH, and intraventricular hemorrhage were associated with procedure related complication (p < 0.05).
CONCLUSION
Endovascular coil embolization is a minimally invasive procedure, but incidence of its complication is not low, especially in SAH. BAC can be a good tool to avoid poor outcome from unexpected IAR during coiling. While IA tirofiban injection is a useful therapy in TE during coiling, sometimes we are aware of the risk of the early rebleeding in SAH patients.

Keyword

Aneurysm; Coil embolization; Intraprocedural aneurysm rupture; Thromboembolism

MeSH Terms

Aneurysm*
Embolization, Therapeutic
Female
Hemorrhage
Humans
Incidence
Intracranial Aneurysm
Logistic Models
Multivariate Analysis
Risk Factors
Rupture
Subarachnoid Hemorrhage
Thromboembolism

Reference

1. Barker FG 2nd, Amin-Hanjani S, Butler WE, Hoh BL, Rabinov JD, Pryor JC, et al. Age-dependent differences in short-term outcome after surgical or endovascular treatment of unruptured intracranial aneurysms in the United States, 1996-2000. Neurosurgery. 2004; 1. 54(1):18–28. PMID: 14683537.

2. Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A. Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke. 1999; 2. 30(2):470–476. PMID: 9933290.

3. Brinjikji W, McDonald JS, Kallmes DF, Cloft HJ. Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms. Stroke. 2013; 5. 44(5):1343–1347. PMID: 23598522.

4. Cloft HJ, Kallmes DF. Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. AJNR Am J Neuroradiol. 2002; Nov-Dec. 23(10):1706–1709. PMID: 12427628.

5. Health Quality Ontario. Coil embolization for intracranial aneurysms: an evidence-based analysis. Ont Health Technol Assess Ser. 2006; 6(1):1–114.

6. Jennett B, Snoek J, Bond MR, Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981; 4. 44(4):285–293. PMID: 6453957.

7. Kang HS, Kwon BJ, Roh HG, Yoon SW, Chang HW, Kim JE, et al. Intra-arterial tirofiban infusion for thromboembolism during endovascular treatment of intracranial aneurysms. Neurosurgery. 2008; 8. 63(2):230–237. discussion 237-8. PMID: 18797352.

8. Li H, Pan R, Wang H, Rong X, Yin Z, Milgrom DP, et al. Clipping versus coiling for ruptured intracranial aneurysms: a systematic review and meta-analysis. Stroke. 2013; 1. 44(1):29–37. PMID: 23238862.

9. Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, et al. Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol. 2005; 3. 26(3):506–514. PMID: 15760857.

10. Pierot L, Spelle L, Leclerc X, Cognard C, Bonafe A, Moret J. Endovascular treatment of unruptured intracranial aneurysms: comparison of safety of remodeling technique and standard treatment with coils. Radiology. 2009; 6. 251(3):846–855. PMID: 19318586.

11. Ross IB, Dhillon GS. Complications of endovascular treatment of cerebral aneurysms. Surg Neurol. 2005; 7. 64(1):12–18. PMID: 15993171.

12. van der Schaaf I, Algra A, Wermer M, Molyneux A, Clarke M, van Gijn J, et al. Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2005; (4):CD003085. PMID: 16235314.