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Acutely ruptured intracranial saccular aneurysms treated with stent assisted coiling: complications and outcomes in 42 consecutive patients
  1. R A Taylor1,2,3,4,
  2. R C Callison5,
  3. C O Martin6,
  4. M Hayakawa5,
  5. J C Chaloupka5
  1. 1Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
  3. 3Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota, USA
  5. 5Division of Neurointerventional Radiology, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  6. 6Saint Luke's Hospital, Kansas City, Missouri, USA
  1. Correspondence to Dr R A Taylor, Departments of Neurology, Neurosurgery and Radiology, University of Minnesota, MMC 295, 420 Delaware St SE, Minneapolis, MN 55455, USA; rataylor{at}umn.edu

Abstract

Background Antiplatelet agents are required to prevent thromboembolic complications from recently deployed intracranial stents, yet they carry a risk of bleeding complications that may be serious in patients with recent subarachnoid hemorrhage.

Method Consecutive patients at a single institution who had ruptured intracranial saccular aneurysms treated with stent assisted coiling were retrospectively reviewed. Our primary outcomes were ischemic stroke related to the stent and bleeding complications possibly related to antithrombotic therapy. Secondary outcomes included 3 month follow-up National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores.

Results 44 aneurysms in 42 patients were treated. Seven patients experienced ischemic strokes during their hospitalization. Five ischemic strokes were secondary to vasospasm; one was definitely related to thrombus formation within the stent and one was possibly related to the stent. Two patients had asymptomatic intracranial hemorrhages and one patient had a symptomatic intracranial hemorrhage. Patients with Hunt and Hess grades I–II (n=25) experienced no stent associated ischemic strokes or symptomatic intracranial hemorrhages. The two stent associated ischemic strokes and one symptomatic intracranial hemorrhage occurred in patients with Hunt and Hess grades III–V (n=17) and patients with external ventricular drains (EVDs) (n=17). Only one patient had disability at the 3 month follow-up that was possibly related to the stent (mRS score of 3 and NIHSS score of 2).

Conclusion These data suggest that higher grade hemorrhage patients, especially those with EVDs, are at greater risk for ischemic stroke and/or bleeding complications than lower grade patients. However, the complications had a small impact on mid-term disability outcomes in this cohort.

  • Subarachnoid
  • Aneurysm
  • Coil
  • Complication
  • Stent
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Footnotes

  • Competing interests JCC is a consultant for Boston Scientific and has received honoraria for proctoring Neuroform stent cases.

  • Ethics approval This study was conducted with the approval of the the institution's internal review board.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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