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Hemorrhagic stroke
Original research
Delayed thromboembolic events after coiling of unruptured intracranial aneurysms in a prospective cohort of 335 patients
  1. Laurent Pierot1,
  2. Coralie Barbe2,
  3. Denis Herbreteau3,
  4. Jean-Yves Gauvrit4,
  5. Anne-Christine Januel5,
  6. Fouzi Bala6,
  7. Frédéric Ricolfi7,
  8. Hubert Desal8,
  9. Stéphane Velasco9,
  10. Mohamed Aggour10,
  11. Emmanuel Chabert11,
  12. Jacques Sedat12,
  13. Denis Trystram13,
  14. Gaultier Marnat14,
  15. Sophie Gallas15,
  16. Georges Rodesch16,
  17. Frédéric Clarençon17,
  18. Chrysanthi Papagiannaki18,
  19. Phil White19,20,
  20. Laurent Spelle15
  1. 1Neuroradiology, CHU Reims, Reims, Champagne-Ardenne, France
  2. 2Department of Research and Public Health, CHU Reims, Reims, Champagne-Ardenne, France
  3. 3Neuroradiology, CHU Tours, Tours, Centre, France
  4. 4Neuroradiology, CHU Rennes, Rennes, Bretagne, France
  5. 5Neuroradiology, CHU Toulouse, Toulouse, Midi-Pyrénées, France
  6. 6Interventional Neuroradiology, CHU Lille, Lille, Hauts-de-France, France
  7. 7Neuroradiology, CHU Dijon, Dijon, Bourgogne, France
  8. 8Neuroradiology, CHU Nantes, Nantes, Pays de la Loire, France
  9. 9Radiology, CHU Poitiers, Poitiers, France
  10. 10Neuroradiology, CHU Saint-Etienne, Saint-Etienne, France
  11. 11Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
  12. 12Neurointervention, CHU Nice, Nice, Provence-Alpes-Côte d'Azur, France
  13. 13Neuroradiology, Centre Hospitalier Sainte Anne, Paris, Île-de-France, France
  14. 14Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
  15. 15Neuroradiology, APHP, Le Kremlin-Bicetre, Île-de-France, France
  16. 16Neuroradiology, Hôpital Foch, Suresnes, Île-de-France, France
  17. 17Neuroradiology, APHP, Hôpital Pitié-Salpêtrière, Paris, Île-de-France, France
  18. 18Interventional Neuroradiology, CHU Rouen, Rouen, Normandie, France
  19. 19Institute for Ageing & Health, Newcastle University, Newcastle upon Tyne, UK
  20. 20Neuroradiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  1. Correspondence to Dr Laurent Pierot, Radiology, CHU Reims, 51092 Reims, France; lpierot{at}gmail.com

Abstract

Background Coiling is the first-line treatment for the management of unruptured intracranial aneurysms (UIAs), but delayed thromboembolic events (TEEs) can occur after such treatment. ARETA (Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm) is a prospective multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed TEEs in the UIA subgroup.

Methods Sixteen neurointerventional departments prospectively enrolled patients treated for ruptured and unruptured aneurysms between December 2013 and May 2015. Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. Data were analyzed from participants with UIA treated by coiling or balloon-assisted coiling. We assessed the rates, timing, management, clinical outcomes, and risk factors for delayed TEEs using univariable and multivariable analyses.

Results The rate of delayed TEEs was 2.4% (95% CI 1.0% to 4.6%) in patients with unruptured aneurysms, with all events occurring in the week following the procedure. In multivariate analysis, two factors were associated with delayed TEEs: autosomal dominant polycystic kidney disease (ADPKD): 20.0% in patients with ADPKD vs 1.9% in patients without ADPKD (OR 27.3 (95% CI 3.9 to 190.2), p=0.0008) and post-procedure aneurysm remnant: 9.4% in patients with post-procedure aneurysm remnant vs 1.6% in patients with adequate occlusion (OR 9.9 (95% CI 1.0 to 51.3), p=0.006). We describe modalities of management as well as clinical outcomes.

Conclusions Delayed TEE is a relatively rare complication after coiling of UIAs. In this series, all occurred in the week following the initial procedure. Two factors were associated with delayed TEE: ADPKD and aneurysm remnant at procedure completion.

Clinical trial registration NCT01942512

  • aneurysm
  • coil
  • complication

https://doi.org/10.1136/neurintsurg-2020-016654

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    Footnotes

    • Contributors Conception or design of the work: LP, CB. Data collection: All authors. Data analysis and interpretation: CB, PW, LS. Drafting the article: LP, CB. Critical revision of the article: PW, LS. Final approval of the version to be published: All authors.

    • Funding The French Health Ministry has funded ARETA (Programme Hospitalier de Recherche Clinique, No. 12-001-0372).

    • Competing interests None declared.

    • Patient consent for publication Not required.

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

    • Data availability statement Data are available upon reasonable request by contacting the corresponding author.