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Types of thromboembolic complications in coil embolization for intracerebral aneurysms and management

Title
Types of thromboembolic complications in coil embolization for intracerebral aneurysms and management
Authors
Kim H.-K.Hwang S.-K.Kim S.-H.
Ewha Authors
김성학황승균
SCOPUS Author ID
김성학scopus; 황승균scopus
Issue Date
2009
Journal Title
Journal of Korean Neurosurgical Society
ISSN
2005-3711JCR Link
Citation
vol. 46, no. 3, pp. 226 - 231
Indexed
SCIE; SCOPUS WOS scopus
Abstract
Objective : We describe our clinical experiences and outcomes in patients who had thromboembolic complications occurring during endovascular treatment of intracerebral aneurysms with a review of the literature. The types of thromboembolic complications were divided and the treatment modalities for each type were described. Methods : Between August 2004 and March 2009 we performed endovascular embolization with Guglielmi detachable coils for 173 patients with 189 cerebral aneurysms, including ruptured and unruptured aneurysms at our hospital. Sixty-eight patients were males and 105 patients were females. The age of patients ranged from 22-82 years (average, 58.8 years). We retrospectively evaluated this group with regard to complication rates and outcomes. The types of thromboembolic complications were classified into the following three categories: mechanical obstruction, distal embolic stroke, and stent-induced complications, which corresponded to types I, II, and III, respectively. A comparison of the clinical results was made for each type of complication. Results : Only eight patients had a thromboembolic complication during or after a procedure (4.6%). Of the eight patients, two had a mechanical obstruction as the causative factor; the other three patients had distal embolic stroke as the causative factor. The remaining three patients had stent-induced complications. In cases of mechanical obstruction, recanalization occurred due to the use of intra-arterial thrombolytic agents in one of two patients. Nevertheless, a poor prognosis was seen. In the cases of stent-induced complications, in one of three patients in whom a thrombus developed following stent insertion, a middle cerebral artery territory infarct developed with a poor prognosis despite the use of wiring and an intra-arterial thrombolytic agent. In the cases of distal embolic stroke, all three patients achieved good results following the use of antiplatelet agents. Conclusion : Treatment for thromboemboic complications due to mechanical obstruction and stent-induced complications include antiplatelet and intra-arterial thrombolytic agents; however, this cannot guarantee a sufficient extent of effectiveness. Therefore, active treatments, such as balloon angioplasty, stent insertion, and clot extraction, are helpful. Copyright ©2009 The Korean Neurosurgical Society.
DOI
10.3340/jkns.2009.46.3.226
Appears in Collections:
의학전문대학원 > 의학과 > Journal papers
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