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Hemorrhagic Complications Related to the StentRemodeled Coil Embolization of Intracranial Aneurysms

Kim, Dong Joon MD, PhD; Suh, Sang Hyun MD; Kim, Byung Moon MD; Kim, Dong Ik MD, PhD; Huh, Seung Kon MD, PhD; Lee, Jae Whan MD

doi: 10.1227/01.NEU.0000370937.70207.95
Clinical Studies

OBJECTIVE: To evaluate the postprocedural hemorrhagic complications associated with stent-remodeled coil embolization of intracranial aneurysms.

METHODS: From the database of 163 cases of stent-remodeled therapy for wide-neck intracranial aneurysms, patients who showed intracranial hemorrhagic complications on follow-up brain imaging were selected. The initial presentation, antithrombotic medication, hemorrhagic type, location, amount, association with ventriculostomy, symptomatic involvement, and outcome were assessed.

RESULTS: Ten patients (6.1%) developed intracranial hemorrhagic complications (range; 0–422 days; mean; 56 days). The hemorrhagic complication rate was higher in patients with acute subarachnoid hemorrhage (20%, 6 of 30 patients) than in patients with unruptured aneurysms (3%, 4 of 133 patients). Nine of the 10 patients were on dual-antiplatelet therapy at the time of hemorrhage development. Seven of the hemorrhages developed in patients with ventriculostomies (intraparenchymal, n = 4; subdural hematoma, n = 3). Three patients who did not receive a ventriculostomy also developed intracranial hemorrhage (n = 1) or intraparenchymal hemorrhage (n = 2). Hemorrhagic transformation in the recently infarcted brain tissue seemed to be the cause of nonventriculostomy related intraparenchymal hemorrhage. The hemorrhages were accompanied by symptomatic aggravation in 6 of 10 cases, with 5 cases resulting in moribund clinical outcome.

CONCLUSION: Postprocedural intracranial hemorrhage may be a risk of stent-remodeled therapy while the patient is on dual-antiplatelet medication. Extra caution is warranted especially in patients with acute subarachnoid hemorrhage requiring ventriculostomy or with underlying recent brain infarction.

Department of Radiology, Research Institute of Radiological Sciences, Yonsei University College of Medicine, Seoul, Korea (Joon Kim) (Suh) (Moon Kim) (Ik Kim)

Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea (Huh) (Lee)

Reprint requests: Dong Ik Kim, MD, PhD, Dept of Radiology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemoon-gu, Seoul, Korea 120–752. E-mail: dikim@yuhs.ac

Received, March 18, 2009.

Accepted, November 22, 2009.

Copyright © by the Congress of Neurological Surgeons