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Original research
Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases
  1. M L Hahnemann1,
  2. A Ringelstein1,
  3. I E Sandalcioglu2,
  4. S Goericke1,
  5. C Moenninghoff1,
  6. I Wanke1,3,
  7. M Forsting1,
  8. U Sure2,
  9. M Schlamann1
  1. 1Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany
  2. 2Department of Neurosurgery, University Hospital Essen, Essen, NRW, Germany
  3. 3Department of Neuroradiology, Clinic Hirslanden, Zürich, Switzerland
  1. Correspondence to Dr Maria L Hahnemann, Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW 45147, Germany; maria.hahnemann{at}uk-essen.de

Abstract

Purpose New ischemic brain lesions are common findings after cerebral diagnostic angiography and endovascular therapy. Diffusion-weighted MRI (DWI) can be used for detection of these lesions. The aim of the present study was to investigate the incidence of DWI lesions after stent-assisted coiling and the evaluation of possible risk factors.

Methods The study included a total of 75 consecutive patients treated with stent-assisted coiling. Post-procedural DWI of the brain was performed to detect ischemic lesions. Demographic data, aneurysm characteristics and angiographic parameters were correlated with properties of DWI lesions.

Results In post-procedural DWI, 48 of the 75 patients (64%) had 163 DWI lesions in a pattern consistent with embolic events. The number of patients with DWI lesions was significantly increased in older patients (≥55 years) and longer intervention times (≥120 min). The ischemic brain volume was significantly increased in older patients (≥55 years) as well as in patients who were implanted with a shorter stent (<20 mm).

Conclusions Thromboembolic events are common after stent-assisted coiling with an incidence comparable to DWI studies after coiling alone. Despite several devices and low operator experience, stent-assisted coiling for intracranial aneurysms has a very low risk of permanent neurologic disability. Further studies are necessary to improve the safety of stent-assisted coiling for patients in conditions with increased risk potential (age, procedure time, stent length).

  • Aneurysm
  • Coil
  • Stent

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