Abciximab Treatment Modalities for Thromboembolic Events Related to Aneurysm Coiling

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. ons503-ons508 ◽  
Author(s):  
Mohamed Aggour ◽  
Laurent Pierot ◽  
Krisztof Kadziolka ◽  
Philippe Gomis ◽  
Jean-Pierre Graftieaux
Keyword(s):  
Scale Score ◽  
Coil Embolization ◽  
Treatment Modalities ◽  
Parent Artery ◽  
Thromboembolic Events ◽  
Modified Rankin Scale ◽  
Thromboembolic Complications ◽  
Unruptured Aneurysms ◽  
Hemorrhagic Complications ◽  
Flow Restoration

ABSTRACT BACKGROUND: Thromboembolic complications are the most common cause of periprocedural morbidity associated with the endovascular treatment of intracranial aneurysms with detachable coils. OBJECTIVE: To estimate the safety and efficacy of using combined intra-arterial and intravenous abciximab to treat thrombi complicating endovascular cerebral aneurysm coil embolization. METHODS: In a retrospective analysis of 390 aneurysmal coiling procedures, we identified 39 patients (10.0%) with thromboembolic events related to the procedure. As the first line of treatment in 23 of these patients, abciximab was administered intra-arterially as a bolus followed by intravenous infusion over a 12-hour period. Eleven of the 23 patients were treated for ruptured aneurysms, 9 for unruptured aneurysms, and 3 for aneurysmal recanalization. Flow restoration and neurological outcome were evaluated. RESULTS: Amelioration as measured by the Thrombolysis in Myocardial Infarction flow grade score was achieved in 17 of 23 patients (73.9%), and no change was observed in 6 of 23 patients (26.1%). Complete recanalization was achieved in 13 patients (56.5%). A greater response to abciximab was noted for thrombi at the coil–parent artery interface, and a lesser response was noted for distal thrombi. No hemorrhagic complications were noted for any of the patients, whereas 11 patients (47.8%) showed ischemic lesions. A modified Rankin Scale score of 2 or less was achieved in 17 of 23 patients (73.9%), whereas 6 of 23 patients (26.1%) had a modified Rankin Scale score of more than 2. CONCLUSION: Combined intra-arterial/intravenous administration of abciximab is safe and effective for treating thromboembolic complications that occur during aneurysmal coil embolization with no hemorrhagic complications.

Challenges in the Management of Ruptured and Unruptured Brainstem Arteriovenous Malformations: Outcome After Conservative, Single-Modality, or Multimodality Treatments

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 155-161 ◽  
Author(s):  
Laurent Thines ◽  
Amir R. Dehdashti ◽  
Leodante da Costa ◽  
Michael Tymianski ◽  
Karel G. ter Brugge ◽  
...  
Keyword(s):  
Scale Score ◽  
Odds Ratio ◽  
Arteriovenous Malformations ◽  
Negative Impact ◽  
Multimodality Treatment ◽  
Treatment Modalities ◽  
Modified Rankin Scale ◽  
Mortality And Morbidity ◽  
Cure Rates ◽  
Single Modality

Abstract BACKGROUND Brainstem arteriovenous malformations are challenging lesions, and benefits of treatment are uncertain. OBJECTIVE To study the clinical course of Brainstem arteriovenous malformations and the influence of treatments on outcome. METHODS We reviewed a prospective series of 31 brainstem arteriovenous malformations. Demographic, morphological, and clinical characteristics were recorded. Factors determining initial and final outcomes (modified Rankin Scale), results of treatments (cure rates, complications), and disease course were analyzed. RESULTS Brainstem arteriovenous malformations were symptomatic and bled in 93% and 61% of cases, respectively. Examination was abnormal and initial modified Rankin Scale score was > 3 in 71% and 86% of patients, respectively. The average follow-up time was 6.2 years, and 26% of patients rebled (5.9 %/y). Treatment modalities included conservative, radiosurgical, endovascular, surgical, and multimodality treatment in 13%, 58%, 35%, 16%, and 26% of cases, respectively. The obliteration rate was 60% overall and 39% after radiosurgery, 40% after embolization, and 75% after microsurgery, with respective complication-free cure rates of 71%, 50%, and 0%. Overall procedural mortality and morbidity were 2.3% and 18.6%, respectively. Final modified Rankin Scale score was > 3 in 77% of cases. Neurological deterioration (35%) was related to treatment complications in 74% of cases with a negative impact of surgery (P = .04), palliative embolization (odds ratio = 16), and multimodality treatments (odds ratio = 24). Radiosurgery was inversely associated with worsening (odds ratio = 0.06). CONCLUSION Brainstem arteriovenous malformations require individualized treatment decisions. Single-modality treatments with a reasonable chance of complete cure and low complication rate (such as radiosurgery) should be favored.

Thromboembolic Complications of Elective Coil Embolization of Unruptured Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 743-748 ◽  
Author(s):  
Gyojun Hwang ◽  
Chulkyu Jung ◽  
Sukh Que Park ◽  
Hyun Sung Kang ◽  
Sang Hyung Lee ◽  
...  
Keyword(s):  
Complication Rate ◽  
Coil Embolization ◽  
Single Agent ◽  
Thromboembolic Complication ◽  
Thromboembolic Complications ◽  
Unruptured Aneurysms ◽  
Complication Risk ◽  
Group 2 ◽  
Risk Of Hemorrhage ◽  
Group 1

Abstract OBJECTIVE We retrospectively evaluated whether antiplatelet preparation lowered the thromboembolic complication rate during the perioperative period. METHODS We reviewed 328 elective coil embolization procedures in which only microcatheters were used for coiling. No antiplatelet medication was prescribed before the procedure in 95 cases (29%, group 1), whereas antiplatelet therapy was used in 233 cases (71%, group 2; 61 [18.6%] with a single agent [aspirin or clopidogrel] and 172 [52.4%] with both agents). Antiplatelet agents were not given after coiling unless atherosclerosis, severe coil protrusion, or a thromboembolic complication occurred during the procedure. A thromboembolic complication was defined as a procedural thromboembolic event or transient ischemic attack or stroke occurring within 2 days of embolization. RESULTS Thromboembolic complications occurred in 11 cases (3.4%): 6 (6.3%) in group 1 and 5 (2.1%) in group 2 (P = .085). In 195 cases (59.5%) treated by the single microcatheter technique, the risk of thromboembolic complications was low and not affected by antiplatelet preparation (1.8% [no preparation] vs 2.2% [preparation]; P = 1.000). However, in 133 cases (40.5%) treated by the multiple microcatheter technique, antiplatelet preparation significantly reduced the thromboembolic complication risk by 85.2% (12.8% [no preparation] vs 2.1% [preparation]; odds ratio, 0.148; 95% confidence interval, 0.027–0.798; P = .023). The aneurysms treated by the multiple microcatheter technique had more complex configurations for coiling (P < .001). The risk of hemorrhage was not increased by antiplatelet preparation (P = .171). CONCLUSION Antiplatelet preparation lowered the periprocedural thromboembolic complication rate in unruptured aneurysms treated by the multiple microcatheter technique and did not increase the risk of hemorrhage. Therefore, antiplatelet preparation can help to reduce complications in patients in whom technical difficulties are expected without the risk of hemorrhage.

scholarly journals Coil Knotting during Endovascular Coil Embolization for Ruptured MCA Aneurysm

2008 ◽  
Vol 14 (3) ◽  
pp. 331-334
Author(s):  
S.C. Kwon ◽  
I.U. Lyo ◽  
S.H. Shin ◽  
J.B. Park ◽  
Y. Kim
Keyword(s):  
Coil Embolization ◽  
Present Report ◽  
Cerebral Aneurysms ◽  
Thromboembolic Events ◽  
Related Complication ◽  
Parent Vessel ◽  
Aneurysmal Rupture ◽  
Hemorrhagic Complications ◽  
Endovascular Coil Embolization ◽  
Mca Aneurysm

Complications during coil embolization of cerebral aneurysms include thromboembolic events, hemorrhagic complications related to procedural aneurysmal rupture and parent vessel perforation, and coil-related complications. The present report describes a rare coil-related complication involving spontaneous coil knotting.

Subarachnoid hemorrhage and the female sex: analysis of risk factors, aneurysm characteristics, and outcomes

2014 ◽  
Vol 121 (6) ◽  
pp. 1367-1373 ◽  
Author(s):  
Alhafidz Hamdan ◽  
Jonathan Barnes ◽  
Patrick Mitchell
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Treatment Modalities ◽  
Modified Rankin Scale ◽  
Related Factors ◽  
Poor Outcome

Object The pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH) is unclear. Sex may play a role in the outcome of patients with aSAH. Methods The authors retrospectively identified 617 patients with aSAH (April 2005 to February 2010) and analyzed sex differences in risk factors (age, hypertension, smoking, alcohol consumption, and family history), admission-related factors (World Federation of Neurosurgical Societies grade and admission delay), aneurysm characteristics (site, side, location, and multiplicity), and outcomes (treatment modalities [coiling/clipping/both/conservative], complications [vasospasm and hydrocephalus], length of stay, and modified Rankin Scale score at 3 months). Results The female patients with aSAH were older than the male patients (mean age 56.6 vs 51.9 years, respectively, p < 0.001), and more women than men were ≥ 55 years old (56.2% vs 40.4%, respectively, p < 0.001). Women exhibited higher rates of bilateral (6.8% vs 2.6%, respectively, p < 0.05), multiple (11.5% vs 5.2%, respectively, p < 0.05), and internal carotid artery (ICA) (36.9% vs 17.5%, respectively, p < 0.001) aneurysms and a lower rate of anterior cerebral artery aneurysms (26.3% vs 44.8%, respectively, p < 0.001) than the men, but no side differences were noted. There were no sex differences in risk factors, admission-related factors, or outcome measures. For both sexes, outcomes varied according to aneurysm location, with odds ratios for a poor outcome of 1.62 (95% CI 0.91–2.86, p = 0.1) for middle cerebral artery, 2.41 (95% CI 1.29–4.51, p = 0.01) for ICA, and 2.41 (95% CI 1.29–4.51, p = 0.006) for posterior circulation aneurysms compared with those for anterior cerebral artery aneurysms. The odds ratio for poor outcome (modified Rankin Scale score of 4–6) in women compared with men after adjusting for significant prognostic factors was 0.71 (95% CI 0.45–1.11, p > 0.05). Conclusions The overall outcomes after aSAH between women and men are similar.

scholarly journals Consideration on Thromboembolic Complications of Stent Assisted Coil Embolization of Unruptured Aneurysms

2013 ◽  
Vol 41 (4) ◽  
pp. 247-252
Author(s):  
Akiyo SADATO ◽  
Motoharu HAYAKAWA ◽  
Teppei TANAKA ◽  
Takeya WATABE ◽  
Kazuhide ADACHI ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Thromboembolic Complications ◽  
Unruptured Aneurysms

Predictors of Outcome, Complications, and Recanalization of the Solitaire Device

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. 355-361 ◽  
Author(s):  
Badih Daou ◽  
Nohra Chalouhi ◽  
Robert M. Starke ◽  
Richard Dalyai ◽  
Kate Hentschel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Univariate Analysis ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
Flow Restoration ◽  
The Mean

Abstract BACKGROUND: The use of mechanical thrombectomy in the management of acute ischemic stroke is becoming increasingly popular. OBJECTIVE: To identify notable factors that affect outcome, revascularization, and complications in patients with acute ischemic stroke treated with the Solitaire Flow Restoration Revascularization device. METHODS: Eighty-nine patients treated with the Solitaire Flow Restoration Revascularization device (ev3/Covidien Vascular Therapies, Irvine, California) were retrospectively analyzed. Three endpoints were considered: revascularization (Thrombolysis In Cerebral Infarction), outcome (modified Rankin Scale score), and complications. Univariate analysis and multivariate logistic regression were conducted to determine significant predictors. RESULTS: The mean time from onset of symptoms to the start of intervention was 6.7 hours. The average procedure length was 58 minutes. The mean NIH Stroke Scale (NIHSS) score was 16 on arrival and 8 at discharge. Of the patients, 6.7% had a symptomatic intracerebral hemorrhage, 16.8% had fatal outcomes within 3 months post-intervention, and 81.4% had a successful recanalization. Thrombus location in the M1 segment of the middle cerebral artery was associated with successful recanalization (thrombolysis in cerebral infarction 2b/3) (P = .003). Of the patients, 56.6% had a favorable outcome (modified Rankin Scale score at 3 months: 0–2). In patients younger than 80 years of age, 66.7% had favorable outcome. Increasing age (P = .01) and NIHSS score (P = .002) were significant predictors of a poor outcome. On multivariate analysis, NIHSS score on admission (P = .05) was a predictor of complications. On univariate analysis, increasing NIHSS score from admission to 24 hours after the procedure (P = .05) and then to discharge (P = .04) was a predictor of complications. Thrombus location in the posterior circulation (P = .04) and increasing NIHSS score (P = .04) predicted mortality. CONCLUSION: The Solitaire device is safe and effective in achieving successful recanalization after acute ischemic stroke. Important factors to consider include age, NIHSS score, and location.

Rescue mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms

2016 ◽  
Vol 9 (3) ◽  
pp. 244-249 ◽  
Author(s):  
Jun Hyong Ahn ◽  
Hyo Sub Jun ◽  
Joon Ho Song ◽  
Byung Moon Cho ◽  
Ho Kook Lee ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Mechanical Thrombectomy ◽  
Thromboembolic Complications ◽  
Parent Vessel ◽  
Safety And Efficacy ◽  
Ruptured Aneurysms ◽  
Hemorrhagic Complications ◽  
Ruptured Intracranial Aneurysms ◽  
Retrievable Stent

ObjectiveTo examine the safety and efficacy of mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.MethodsBetween June 2011 and June 2015, 631 consecutive patients with ruptured intracranial aneurysms underwent coil embolization at 6 hospitals. Among 53 patients who had thromboembolic complications, 15 patients harboring 15 aneurysms underwent rescue mechanical thrombectomy with a retrievable stent for the treatment of thromboembolic occlusion during the coiling of ruptured aneurysms. The patients' clinical and radiologic outcomes were retrospectively reviewed.ResultsOf the 15 aneurysms, coiling alone was used for 13 (86.7%), and stent-assisted coiling was performed for 2 (13.3%). Thromboembolic occlusion most frequently occurred distal to the aneurysm (n=10, 66.7%), followed by proximal to the aneurysm (n=3, 20%), and at the coil−parent vessel interface (n=2, 13.3%). All patients underwent mechanical thrombectomy with a retrievable stent, including 5 patients who were initially treated with an IA tirofiban infusion. Complete recanalization (Thrombolysis in Cerebral Infarction (TICI) 3) was obtained in 13 (86.7%) and partial recanalization (TICI 2b) in 2 (13.3%). Two patients who had received IA tirofiban before mechanical thrombectomy had hemorrhagic complications. At 6 months after discharge, 9 patients had a modified Rankin Scale (mRS) score of 1, 3 patients were mRS 2, 1 patient was mRS 3, 1 patient was mRS 4, and 1 patient was mRS 6.ConclusionsRescue mechanical thrombectomy using a retrievable stent can be a useful treatment for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.

scholarly journals Angiographic findings of in-stent intimal hyperplasia after stent-assisted coil embolization: are they permanent findings?

2016 ◽  
Vol 124 (2) ◽  
pp. 328-333 ◽  
Author(s):  
Young Soo Kim ◽  
Sang Won Lee ◽  
Jeong A Yeom ◽  
Chang Hyo Yoon ◽  
Seung Kug Baik
Keyword(s):  
Stent Implantation ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Additional Treatment ◽  
Parent Artery ◽  
Related Factors ◽  
Conventional Angiography ◽  
Unruptured Aneurysms ◽  
Luminal Narrowing

OBJECT Stent-assisted coil embolization for the treatment of intracranial aneurysms has been used widely. This study aimed to investigate the effect of stent implantation in the nonatherosclerotic parent artery with cerebral aneurysms. The authors evaluated luminal changes and the related factors following stent-assisted coil embolization. METHODS This study included 97 patients harboring a total of 99 unruptured aneurysms of the distal internal carotid artery (ICA) who underwent single-stent implantation and more than 1 session of conventional angiography during follow-up (midterm follow-up only, n = 70; midterm and long-term follow-up, n = 29) between January 2009 and April 2014. The luminal narrowing point was measured using a local thickness map (ImageJ plug-in). RESULTS Stent-assisted coil embolization caused dynamic luminal narrowing of approximately 82% of the parent artery diameter on average after 8 months, which was reversed to 91% after 25 months. In addition, luminal narrowing greater than 40% was noticed in 2 (7%) of the 29 patients who experienced spontaneous reversion without additional management during follow-up. Most luminal narrowing changes seen were diffuse. CONCLUSIONS Luminal narrowing after aneurysm stent-assisted coil embolization is a dynamic process and appears to be a spontaneously reversible event. Routine management of luminal narrowing may not cause adverse events that require additional treatment.

scholarly journals Clinical Results and Pathological Findings of Stent-Assisted Coil Embolization for Basilar Artery Trunk Dissecting Aneurysms

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 95-99 ◽  
Author(s):  
H. Nagashima ◽  
K. Hongo ◽  
Y. Matsumoto ◽  
F. Oya ◽  
S. Kobayashi ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Pathological Finding ◽  
Clinical Results ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Thromboembolic Complications ◽  
Pathological Findings ◽  
Effective Treatment Option ◽  
Dissecting Aneurysms

Stent-assisted coil embolization is a new method for treating dissecting or fusiform aneurysm, especially the aneurysms arising from the basilar artery trunk or dominant vertebral artery. At present, this technique is considered as an effective treatment option to obliterate such aneurysm keeping the parent artery patent. Several authors reported the effectiveness and excellent radiological result of this treatment, but fewer reports focus on the limitations of this technique. We treated two patients with a basilar artery trunk dissecting aneurysm with this technique. Transient ischemic symptoms were observed in one patient and haemorrhagic and thromboembolic complications were observed the other. We lost the latter patient due to postoperative complications, and the pathological finding was achieved by autopsy. We report the clinical and pathological findings in the two cases and investigate the efficacy and limitations of this technique.

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