Intraprocedural abciximab bolus versus pretreatment oral dual antiplatelet medication for endovascular stenting of unruptured intracranial aneurysms

2015 ◽  
Vol 8 (9) ◽  
pp. 909-912 ◽  
Author(s):  
Michael R Levitt ◽  
Karam Moon ◽  
Felipe C Albuquerque ◽  
Celene B Mulholland ◽  
M Yashar S Kalani ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Stenting ◽  
Intracranial Stenting ◽  
Postoperative Mri ◽  
Antiplatelet Medication ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Hemorrhagic Events ◽  
Patient Variables ◽  
Aneurysm Diameter

BackgroundStandard pretreatment with dual antiplatelet medication (DAPM) was compared with a standalone intraprocedural abciximab bolus for the prevention of thromboembolic and hemorrhagic events during endovascular stenting of unruptured intracranial aneurysms.Materials and methodsWe treated 94 patients with 99 aneurysms with intracranial stenting (with or without coiling). Patients were either pretreated with DAPM daily for ≥3 days before stenting (pretreatment group) or received an abciximab bolus during or immediately after stent placement followed by postoperative DAPM (abciximab group), at the treating physician's discretion. Twenty patients underwent immediate postoperative MRI. Demographic, clinical, and radiological information and periprocedural complications were recorded.ResultsThere were 52 procedures in the pretreatment group and 47 in the abciximab group. More flow-diverting stents were placed in the pretreatment group than in the abciximab group (45 vs 23, p<0.001), and the aneurysm diameter was larger (11.2±6.7 vs 8.3±4.7 mm, p=0.01). There were 11 thrombotic and 7 access site complications, with no significant difference between the groups (p>0.99 and p=0.12, respectively). There were no intracranial hemorrhages. In patients with postoperative MRI, there was no difference in the presence of diffusion-restricted lesions between groups (p=0.20). Multivariate analysis of a composite of any complication did not show significant associations with aneurysm or patient variables in either group.ConclusionsStandalone intraprocedural abciximab bolus was not associated with an increased rate of complications compared with pretreatment with DAPM for unruptured intracranial aneurysm stenting.

scholarly journals Antiplatelet Premedication for Stent-Assisted Coil Embolization of Intracranial Aneurysms: Low-Dose Prasugrel vs Clopidogrel

Neurosurgery ◽  
2017 ◽  
Vol 83 (5) ◽  
pp. 981-988 ◽  
Author(s):  
Hyun Ho Choi ◽  
Jung Jun Lee ◽  
Young Dae Cho ◽  
Moon Hee Han ◽  
Won-Sang Cho ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Low Dose ◽  
Significant Risk ◽  
Cerebral Aneurysms ◽  
Significant Risk Factor ◽  
Thromboembolic Events ◽  
Antiplatelet Medication ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference

Abstract BACKGROUND The use of antiplatelet medications to prevent thrombosis in the treatment of cerebral aneurysms with stents has become widely emphasized. OBJECTIVE To compare low-dose prasugrel with clopidogrel in stent-assisted coil embolization of intracranial aneurysms. METHODS This is a retrospective review of 311 aneurysms from 297 patients who underwent stent-assisted endovascular coil embolization of unruptured intracranial aneurysm between November 2014 and March 2017. Thromboembolic and hemorrhagic adverse events were compared between 207 patients who received low-dose prasugrel (PSG group) and 90 patients who received clopidogrel (CPG group). RESULTS P2Y12 reaction unit (PRU) values were significantly lower in the PSG group (PSG group vs CPG group, 132.3 ± 76.9 vs 238.1 ± 69.1; P &lt; .001); the percentage of inhibition was also statistically higher in the PSG group (54.0 ± 26.0% vs 20.8 ± 18.6%; P &lt; .001). Thromboembolic events occurred less frequently in the PSG group than in the CPG group (0.9% vs 6.4%; P = .01), whereas there was no significant difference in the percentage of hemorrhagic complications (0.5% vs 2.2%; P = .22). In the multivariate analysis, clopidogrel as the antiplatelet medication was the sole significant risk factor for thromboembolism in this series of patients undergoing stent-assisted coil embolization. CONCLUSION Use of low-dose PSG as an antiplatelet premedication is quick, effective, and safe for stent-assisted coil embolization of unruptured intracranial aneurysms. Prasugrel premedication significantly lowered the frequency of thromboembolic events without increasing the risk of hemorrhage.

Treatment outcomes of 1-stage clipping of multiple unruptured intracranial aneurysms via keyhole approaches

2021 ◽  
pp. 1-10
Author(s):  
Noah Hong ◽  
Won-Sang Cho ◽  
Chang Hwan Pang ◽  
Young Hoon Choi ◽  
Jin Woo Bae ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Intracranial Aneurysms ◽  
Significant Risk ◽  
Treatment Modalities ◽  
Morbidity Rate ◽  
Chronic Hypertension ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Complete Exclusion ◽  
Permanent Morbidity

OBJECTIVE Complete exclusion of multiple unruptured intracranial aneurysms (UIAs) in one session of intervention may be ideal. However, such situations are not always feasible in terms of treatment modalities and outcomes. The authors aimed to analyze their experience with 1-stage clipping of multiple UIAs. METHODS Medical records between March 2013 and December 2018 were retrospectively reviewed, and 111 1-stage keyhole approaches in 110 patients with 261 multiple UIAs were ultimately included in this study. Clinical and radiological outcomes were analyzed, as well as postoperative complications up to 1 month after the surgery and their risk factors. RESULTS Keyhole approaches included unilateral supraorbital in 87 operations (78.4%), bilateral supraorbital in 12 (10.8%), and others in 12. The mean operative duration was 169.6 minutes (range 80–490 minutes). The highest numbers of aneurysms clipped at once were 2 (73.9%) and 3 (18.9%). Complete exclusion and residual neck of the clipped aneurysms were achieved in 89.3% and 7.3%, respectively. There was no significant difference between pre- and postoperative 1-month neurological states (p = 0.14). The permanent morbidity rate was 1.8% (n = 2), and there were no deaths. Postoperative transient neurological deterioration (TND) with no radiological and electrophysiological abnormalities occurred in 8 operations (7.2%). Hypertension was the only significant risk factor for postoperative TND (adjusted odds ratio 17.03, 95% confidence interval 1.99–2232.24, p = 0.01). CONCLUSIONS One-stage clipping of multiple UIAs via keyhole approaches showed satisfactory treatment outcomes with a low permanent morbidity. Patients with chronic hypertension had a high risk of postoperative TND.

Cognitive Outcome and Clinically Silent Thromboembolic Events After Coiling of Asymptomatic Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2012 ◽  
Vol 72 (4) ◽  
pp. 638-645 ◽  
Author(s):  
Dong-Hun Kang ◽  
Yang-Ha Hwang ◽  
Yong-Sun Kim ◽  
Geum Ye Bae ◽  
Seung Jae Lee
Keyword(s):  
Cognitive Deficits ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Cognitive Outcome ◽  
Cognitively Impaired ◽  
Thromboembolic Events ◽  
Cognitive Changes ◽  
Focal Neurological Deficit ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference

Abstract BACKGROUND: Thromboembolic events are the most common complication after coiling of unruptured intracranial aneurysms (UIAs). However, it remains unclear whether these clinically silent ischemic lesions (CSILs) have any clinical significance. OBJECTIVE: To evaluate cognitive outcome after coil embolization of asymptomatic UIAs and its relationship with CSILs after the procedure. METHODS: We prospectively enrolled 40 UIA patients who showed no new focal neurological deficit after coil embolization. CSILs were assessed with diffusion-weighted imaging (DWI) within 1 day after the procedure. A battery of neuropsychological tests was performed 3 times: preoperatively and postoperatively at 1 and 4 weeks after coil embolization. RESULTS: The incidence of cognitive impairment after coiling in patients with UIAs was 44% (17 of 39) at 1 week and 19% (7 of 37) at 4 weeks after coil embolization. DWI within 1 day after coil embolization revealed that 60% of patients (24 of 40) showed CSILs. However, no significant difference was found in any mean cognitive scores or in the number of cognitively impaired variables between patients with and without CSILs at weeks 1 and 4. Additional correlation analysis revealed no correlations between the number of CSILs on DWI and the cognitive sum z score at both 1 and 4 weeks. CONCLUSION: Exhaustive neuropsychological evaluation of UIA patients who underwent coil embolization demonstrated recovery or improvements from baseline cognitive function after 4 weeks, although some patients still showed cognitive deficits at 4 weeks after the procedure. However, we found no statistically significant relationship between the presence and number of CSILs on DWI and cognitive changes after the procedure.

scholarly journals Ticagrelor versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms

2021 ◽  
pp. 159101992110549
Author(s):  
Shuo-Chi Chien ◽  
Ching-Chang Chen ◽  
Chun-Ting Chen ◽  
Alvin Yi-Chou Wang ◽  
Po-Chuan Hsieh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Systemic Review ◽  
Bleeding Tendency ◽  
Unruptured Intracranial Aneurysms ◽  
Low Dose Aspirin ◽  
Hemorrhagic Events ◽  
One Year

Background Dual antiplatelet therapy is widely used for stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) to prevent thromboembolic events (TEs). Compared to clopidogrel associated with aspirin, knowledge of the safety and efficacy of ticagrelor is lacking in large studies to date. Methods A retrospective cohort study was conducted from January 2016 to December 2018 with at least one year of follow-up in a single institution and systemic review. Results Altogether, 153 patients with UIA receiving SACE were separated into two groups: 113 patients receiving clopidogrel plus aspirin and 40 patients receiving ticagrelor plus aspirin. Acute in-stent thrombotic events were noted in two patients in the clopidogrel group (1.77%) and none in the ticagrelor group (0%). Additionally, one patient (0.88%) in the clopidogrel group had an early ischemic stroke (<3 months). Delayed ischemic stroke was noted in 6 patients (5.31%) in the clopidogrel group and 3 patients (7.50%) in the ticagrelor group. There were no major hemorrhagic events in either group. The two groups showed no significant differences with regard to ischemic stroke or hemorrhagic stroke. Conclusion Compared to the clopidogrel based regimen, ticagrelor can also reduce TEs without increasing bleeding tendency for SACE of UIAs. Ticagrelor combined with low-dose aspirin is a safe and effective alternative option for SACE.

Clinical characteristics associated with sentinel headache in patients with unruptured intracranial aneurysms

2020 ◽  
pp. 159101992097197
Author(s):  
Zheng Wan ◽  
Hao Meng ◽  
Ning Xu ◽  
Tianyi Liu ◽  
Zhongping Chen ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Clinical Characteristics ◽  
Therapeutic Strategy ◽  
Multivariable Analysis ◽  
Clinical History ◽  
Aneurysm Rupture ◽  
Clinical Feature ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Sh Group

Objective Sentinel headache (SH) is considered as a signal of the impending rupture of an aneurysm. However, it is difficult to diagnose whether the headaches of patients are associated with unstable aneurysms. Therefore, there is some doubt about the importance of headaches in patients with unruptured intracranial aneurysms (UIAs). This study was performed to explore the existence and clinical characteristics of SH associated with aneurysms. Methods Thirty-six patients with a single UIA were collected in this study. Patients were symptomatically categorized into two groups: SH and non-SH. The PHASES scores and patient and aneurysm characteristics were analyzed. Two independent MRI experts who were blinded to the patients’ clinical history conducted the analysis of the SWI results. Results There were 15 patients with sentinel headache. No significant difference was found in patient’s basic information and history. The SH group had a higher PHASES score than the non-SH group (P < 0.05). In univariable analysis, abnormal SWI signals were significantly more frequent in the SH group (P < 0.01) and the inflow angle was significantly lower in the non-SH group (P < 0.05). In multivariable analysis, abnormal signals in SWI were an independent factor associated with SH (P < 0.01). Conclusions SH exists in patients with UIAs and may indicate a high risk of aneurysm rupture. Abnormal signals on SWI may serve as a clinical feature to identify aneurysm-related SH and be helpful for the formulation of therapeutic strategy. Aneurysm geometry may also be related to SH but need further studies in the future.

Prophylactic administration of tirofiban for preventing thromboembolic events in flow diversion treatment of intracranial aneurysms

2020 ◽  
pp. neurintsurg-2020-016878
Author(s):  
Qiaowei Wu ◽  
Qiuji Shao ◽  
Li Li ◽  
Xiaodong Liang ◽  
Kaitao Chang ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Intracranial Aneurysms ◽  
Dual Antiplatelet Therapy ◽  
Flow Diverter ◽  
Thromboembolic Events ◽  
Maintenance Infusion ◽  
Prophylactic Administration ◽  
Unruptured Intracranial Aneurysms ◽  
Hemorrhagic Events ◽  
Prophylactic Use

BackgroundFlow diverter (FD) is widely used in the treatment of intracranial aneurysms. However, thromboembolic events (TEs) continue to be the major complications during the periprocedural phase. To evaluate the safety and efficacy of the prophylactic use of tirofiban, combined with the conventional dual antiplatelet therapy (DAT), as a new antiplatelet protocol in patients with intracranial aneurysms treated with FDs.MethodsAt least 3–5 days before the procedure, daily DAT were administrated to the patients. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period during or immediately after FD deployment, followed by a 0.05 µg/kg/min maintenance infusion for 24–48 hours. Periprocedural TEs and hemorrhagic events (HEs) were recorded.ResultsA total of 331 patients were included, including 229 (69.2%) who received tirofiban administration (tirofiban group) and 102 (30.8%) who received only DAT (non-tirofiban group). Periprocedural TEs occurred in 12 (3.6%) patients, including eight (7.8%) in the non-tirofiban group and four (1.7%) in the tirofiban group. In multivariate analysis, patients receiving tirofiban administration had significantly lower TEs as compared with those who received only DAT (P=0.004). Balloon angioplasty and longer procedure time (>137 min) were also risk factors for TEs. Also, no increase was observed in the rate of HEs related to tirofiban administration.ConclusionsThe current study suggested that prophylactic administration of tirofiban combined with conventional oral DAT seems safe and efficient for preventing TEs during FD treatment of unruptured intracranial aneurysms. Balloon angioplasty and prolonged procedure are associated with a high risk of TEs.

Postoperative cognitive dysfunction after endovascular treatments for unruptured intracranial aneurysms: A pilot study

2021 ◽  
pp. 159101992110399
Author(s):  
Daizo Ishii ◽  
Mario Zanaty ◽  
Jorge A Roa ◽  
Luyuan Li ◽  
Yongjun Lu ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cognitive Dysfunction ◽  
Intracranial Aneurysms ◽  
Postoperative Cognitive Dysfunction ◽  
Mean Difference ◽  
Major Surgery ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Normal Cognition ◽  
Moca Score

Objective Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic managements are associated with different cognitive outcomes after endovascular treatments for unruptured intracranial aneurysms (UIAs). The purpose of this study is to assess the correlation of POCD with GA versus monitored anesthesia care (MAC). Methods We performed a pragmatic, prospective study to assess the association between different anesthetic approaches and POCD. We compared the pre- and post-procedural Montreal Cognitive Assessment (MoCA) scores in patients with normal cognition who underwent treatments of UIAs with various endovascular methods, using either GA or MAC. Results A total of 23 patients with UIAs were enrolled in the study. Seven (30.4%) and sixteen (69.6%) UIAs were treated without perioperative complications under GA or MAC, respectively. There was a significant decline in the post-procedural MoCA score under GA (mean difference  =  1.14; 95% confidence interval  =  [0.42–1.87], P < 0.01). By contrast, there was no significant difference of MoCA score between pre- and post-procedure under MAC (mean difference  =  0.19; 95% confidence interval  =  [−0.29–0.67], P  =  0.59). Conclusions Treating UIAs using MAC was associated with a decrease in POCD as compared to GA in patients undergoing endovascular treatments for UIAs with normal cognition. Larger randomized studies are needed to confirm these findings.

Treatment of distal unruptured intracranial aneurysms using a surface-modified flow diverter under prasugrel monotherapy: a pilot safety trial

2021 ◽  
pp. neurintsurg-2020-017262
Author(s):  
Luis Henrique de Castro-Afonso ◽  
Guilherme Seizem Nakiri ◽  
Thiago Giansante Abud ◽  
Lucas Moretti Monsignore ◽  
Rafael Kiyuze Freitas ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Anterior Circulation ◽  
Antiplatelet Medication ◽  
Unruptured Intracranial Aneurysms ◽  
Trial Treatment ◽  
Ischemic Complications ◽  
Carotid Aneurysms ◽  
Surface Modified

BackgroundFlow diverters (FDs) are effective in the treatment of carotid aneurysms. Compared with carotid aneurysms, the treatment of distal intracranial aneurysms with FDs has been associated with a relatively high incidence of complications. Low thrombogenic modified-surface FDs may reduce ischemic complications and allow for the use of a single antiplatelet medication. The aim of this study was to assess the safety and efficacy of the p48 MW HPC Flow Modulation Device (Phenox GmbH, Bochum, Germany) to treat distal intracranial aneurysms used in combination with prasugrel monotherapy.MethodsThis was a single-center, prospective, pivotal, open, single-arm study. Patients were included in this study from December 2019 to September 2020. The primary endpoints were the incidence of any neurologic deficit after treatment until 1 month of follow-up, defined as National Institutes of Health Stroke Scale (NIHSS) ≥1, and the incidence of acute ischemic lesions in magnetic resonance imagin (MRI) images 48 hours after treatment. The secondary endpoint was the rate of complete occlusion of the aneurysms at the 1-month follow-up.ResultsTwenty-one patients harboring 27 distal aneurysms of the anterior circulation were included. Mean age was 57.8 (SD 9.7) years, and 16 patients were female (80%). No patient had neurologic symptoms at the 1-month follow-up. Four patients (20%) had asymptomatic acute brain ischemic lesions on MRI. Complete aneurysm occlusion occurred in 9/27 (33.3%) aneurysms at the 1-month follow-up.ConclusionIn this pilot safety trial, treatment of distal intracranial aneurysms with p48 MW HPC under monotherapy with prasugrel appeared to be safe.

Three-Month Outcome of Carotid Artery Stenting in Patients with/without Coexistent Unruptured Intracranial Aneurysms

2020 ◽  
Vol 49 (4) ◽  
pp. 382-387
Author(s):  
Ximeng Yang ◽  
Jun Lu ◽  
Peng Qi ◽  
Junjie Wang ◽  
Shen Hu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Intracranial Aneurysms ◽  
Dual Antiplatelet Therapy ◽  
Aneurysm Rupture ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Symptomatic Intracranial Hemorrhage ◽  
Baseline Characteristics

Introduction: Safety of carotid artery stenting (CAS) in patients having carotid stenosis with coexistent unruptured intracranial aneurysms (UIAs) is rarely reported. Thus, we studied the 3-month outcome of CAS in the presence of coexistent UIAs in our institution. Methods: A retrospective analysis of patients receiving CAS at our institution from September 2011 to December 2019 was carried out. Patients were stratified into 2 groups: group of CAS with UIAs (CAS-UIA) and group of CAS without UIAs (CAS). The main complications within 3 months after stenting were TIA, ischemic stroke, symptomatic intracranial hemorrhage (sICH), rupture of UIAs, and death. The baseline characteristics and complications of the 2 groups were compared. Results: Five hundred fifty-six patients (CAS, n = 468; CAS-UIA, n = 88) were included and 604 stenting procedures were performed. More patients had hypertension in the CAS-UIA group (87.5 vs. 73.7%, p = 0.006). There was no significant difference in TIAs, ischemic stroke, sICH, and death within 3 months after stenting between the CAS and CAS-UIA groups. None of the 113 coexistent UIAs detected in 88 patients had aneurysm rupture within 3 months after CAS. Conclusions: In our large cohort of CAS patients, coexistent UIAs are not uncommon. Stenting of a carotid artery in the presence of coexistent UIAs could be conducted safely. Together with 3-month dual antiplatelet therapy, CAS did not increase the rupture risk of the coexistent UIAs within 3 months.

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