Temporary Semi-Jailing Technique Avoiding Inevitable Antiplatelet Medication for Coil Embolization of Wide-necked Cerebral Aneurysms

2010 ◽  
Vol 5 (2) ◽  
pp. 103
Author(s):  
Peng-Hua Lü ◽  
Jong Lim Kim ◽  
Jin-Ho Shin ◽  
Sang Joon Kim ◽  
Deok Hee Lee ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Antiplatelet Medication

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 < .001); the percentage of inhibition was also statistically higher in the PSG group (54.0 ± 26.0% vs 20.8 ± 18.6%; P < .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.

scholarly journals Safety of Preprocedural Antiplatelet Medication in Coil Embolization of Ruptured Cerebral Aneurysms at the Acute Stage

2014 ◽  
Vol 20 (4) ◽  
pp. 413-417 ◽  
Author(s):  
Norihito Shimamura ◽  
Masato Naraoka ◽  
Naoya Matsuda ◽  
Hiroki Ohkuma
Keyword(s):  
Antiplatelet Therapy ◽  
Coil Embolization ◽  
Clinical Symptoms ◽  
Thrombus Formation ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Bleeding Complications ◽  
Antiplatelet Medication ◽  
Adverse Influence ◽  
Sheath Insertion

Preoperative antiplatelet medication for aneurysm coil embolization during acute subarachnoid hemorrhage (SAH) is not common. However, recent advances in neurointerventional devices make antiplatelet medication necessary for SAH surgery. We tested the hypothesis that preprocedural antiplatelet therapy in the acute stage of SAH prevents complications due to ischemia or induced bleeding. We retrospectively reviewed 35 consecutive ruptured cerebral saccular aneurysms that underwent coiling at our institute. Two hundred milligrams of aspirin and 150 mg of clopidogrel were administered to the patients at least two hours before coiling. Systemic heparinization was given after sheath insertion. Procedure-related thrombus formation on digital subtraction angiography, and clinical evidence of ischemia and procedure-related stroke on CT were reviewed. The median patient age was 69 years. Five males and 30 females were included. Seventy-seven percent of patients were Hunt-Hess grades 1 to 3. Assist techniques were used in 20 cases (57%). We inserted one extracranial internal carotid artery stent, but no intracranial stent. Intraoperative thrombosis occurred in one case (2.9%), with no clinical symptoms. Postoperative cerebrospinal fluid drainage was done in three cases, but we experienced no bleeding complications. Preoperative antiplatelet therapy leads to a low rate of thromboembolic events in coiling during acute stage SAH, and this strategy had no adverse influence on bleeding complications.

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 182-189
Author(s):  
Tae-Jin Song ◽  
Seung-Hun Oh ◽  
Jinkwon Kim
Keyword(s):  
Statin Therapy ◽  
Coil Embolization ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cerebral Aneurysms ◽  
Time Dependent ◽  
Lipid Lowering ◽  
Surgical Clipping ◽  
The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

scholarly journals Flat Panel Detector Angiographic CT for Stent-Assisted Coil Embolization of Broad-Based Cerebral Aneurysms

2007 ◽  
Vol 28 (10) ◽  
pp. 1902-1908 ◽  
Author(s):  
G. Richter ◽  
T. Engelhorn ◽  
T. Struffert ◽  
M. Doelken ◽  
O. Ganslandt ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Flat Panel ◽  
Flat Panel Detector ◽  
Angiographic Ct

scholarly journals Long Term Angiographical Follow-up of Cerebral Aneurysms after Coil Embolization

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 149-154 ◽  
Author(s):  
Y. Kaku ◽  
K. Hayashi ◽  
M. Sawada ◽  
N. Sakai
Keyword(s):  
Special Reference ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
Platinum Coils

We evaluated long-term angiographical follow-up of cerebral aneurysms treated with detachable platinum coils with special reference to the long-term morphological outcomes of incompletely obliterated aneurysms. Serial long-term follow-up cerebral angiograms (>1 year) were obtained in 47 cases out of 134 cases treated with GDCs or IDCs from 1994 to 1999. In 47 patients, intial angiographical results demonstrated ten complete aneurysmal occlusion, seven aneurysms with a small neck remnant, twenty aneurysms with body filling and ten aneurysms with both of neck remnant and body filling. In the ten completely obliterated aneurysms, follow-up angiograms revealed no aneurysmal recanalization. In seven aneurysms with neck remnant, three remained unchanged, four showed enlargement of contrast filling in the part of the neck of the aneurysm. In twenty aneurysms with body filling, five had developed into complete obliteration, three remained unchanged, 11 had recanalization, and one aneurysm displayed regrowth. In ten aneurysms with both of neck remnant and body filling, two remained unchanged, five had recanalization, and three aneurysms displayed regrowth. Long-term angiographical follow-up results are less satisfactory in cases involving incompletely obliterated lesions. A higher incidence of recanalizations were promoted in cases with neck remnant and/or body filling. Strict follow-up angiography is mandatory when a complete obliteration is not achieved.

Multiple cerebral aneurysms associated with Takayasu arteritis successfully treated with coil embolization

2008 ◽  
Vol 26 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Katsutoshi Takayama ◽  
Hiroyuki Nakagawa ◽  
Satoru Iwasaki ◽  
Toshiaki Taoka ◽  
Kaoru Myouchin ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Coil Embolization ◽  
Cerebral Aneurysms

scholarly journals Y-stent-assisted coil embolization of cerebral aneurysms

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Lee A. Tan ◽  
Andrew K. Johnson ◽  
Kiffon M. Keigher ◽  
Roham Moftakhar ◽  
Demetrius K. Lopes
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Complication Rate ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Link Type

Y-stent–assisted coiling is a technique used by neuroendovascular surgeons to treat complex, wide-necked, bifurcation aneurysms in locations such as basilar tip and middle cerebral artery bifurcation. Several recent studies have demonstrated low complication rate and favorable clinical and angiographic outcomes. The Y-stent technique is illustrated here in detail and the intraoperative nuances are also discussed to minimize potential complications associated with technique.The video can be found here: http://youtu.be/77pEmqx_fyQ.

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