[Stenting plus coiling: dangerous or helpful?].
OBJECTIVE
The purpose of this study was to evaluate the procedural risk of treating acute ruptured aneurysms with a stent-coil combination.


METHODS
Between August 2001 and January 2004 we treated nine acute subarachnoid hemorrhage (SAH) patients with a combination of stents and platinum coils.


RESULTS
Six aneurysms were 100% eliminated; the residual three aneurysms had a 95% to 99% occlusion. A transient thrombosis in the stent in one patient could be recanalized by intravenous application of ReoPro. In another patient an occlusive vasospasm at the distal end of the stent was successfully treated with intraarterial Nimotop. Neurological complications occurred in none of the patients.


CONCLUSIONS
In broad-based aneurysms which cannot be clipped or in which any neurosurgical treatment presents an unacceptably high risk (posterior circulation and paraophthalmic aneurysms), treatment using a combination of stent and platinum coils might be an option even in the acute phase of an SAH. Platelet aggregation can be treated with Aspirin and Plavix after placement of the first coil, vasospasms with intraarterial Nimotop, and acute stent thrombosis with GP IIa/IIIb-antagonists.
Wanke
I
I
Institut für Radiologie und Neuroradiologie. isabel.wanke@uni-essen.de
Gizewski
E
E
Dörfler
A
A
Stolke
D
D
Forsting
M
M
D000208:Acute Disease; D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D002533:Cerebral Angiography; D000077144:Clopidogrel; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D009553:Nimodipine / Q000008:administration & dosage / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D010984:Platinum; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D010984:Platinum; D009553:Nimodipine; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin