Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils.
OBJECTIVE
Ischemic stroke or transient ischemic attack (TIA) may occur after the treatment of intracranial aneurysms with Guglielmi detachable coils (GDCs). The purpose of the present study is to investigate possible risk factors for thromboembolic events and to determine their frequency and time course.


METHODS
The records of 178 consecutive patients with 193 treated intracranial saccular aneurysms were reviewed. A total of 159 GDC procedures were performed to treat 143 aneurysms in 133 of those patients who were in good neurological condition, allowing clinical detection of postprocedure ischemic events (TIA or stroke). The association of clinical, anatomical, and pharmacological factors with intraprocedure intraarterial thrombus and with postprocedure ischemic events was investigated by using uni- and multivariate analyses. Thrombus protruding into the parent artery was noted during six of 159 GDC procedures, resulting in a clinical deficit in one patient. No factor was associated with intraprocedure intraarterial thrombus. Ten postprocedure ischemic events occurred in nine patients. Seven events occurred within 24 hours, and three events occurred between 24 hours and 58 days. Aneurysm diameter and protruding coils were significant independent predictors of postprocedure ischemic events in multivariate analysis (both p = 0.02). The actuarial risk of stroke was 3.8%.


CONCLUSIONS
Larger aneurysm diameter and protruding loops of coils are associated with postprocedure ischemic events after GDC placement. It is unlikely that GDC-treated aneurysms retain thromboembolic potential beyond 2 months.
Derdeyn
Colin P
CP
Interventional Neuroradiology Service, Washington University School of Medicine, St Louis, MO, USA. derdeync@mir.wustl.edu
Cross
DeWitte T
DT
Moran
Christopher J
CJ
Brown
George W
GW
Pilgram
Thomas K
TK
Diringer
Michael N
MN
Grubb
Robert L
RL
Rich
Keith M
KM
Chicoine
Michael R
MR
Dacey
Ralph G
RG
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000453:epidemiology* / Q000209:etiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology