Hemorrhagic complications related to the stent-remodeled coil embolization of intracranial aneurysms.
OBJECTIVE
To evaluate the postprocedural hemorrhagic complications associated with stent-remodeled coil embolization of intracranial aneurysms.


METHODS
From the database of 163 cases of stent-remodeled therapy for wide-neck intracranial aneurysms, patients who showed intracranial hemorrhagic complications on follow-up brain imaging were selected. The initial presentation, antithrombotic medication, hemorrhagic type, location, amount, association with ventriculostomy, symptomatic involvement, and outcome were assessed.


RESULTS
Ten patients (6.1%) developed intracranial hemorrhagic complications (range; 0-422 days; mean; 56 days). The hemorrhagic complication rate was higher in patients with acute subarachnoid hemorrhage (20%, 6 of 30 patients) than in patients with unruptured aneurysms (3%, 4 of 133 patients). Nine of the 10 patients were on dual-antiplatelet therapy at the time of hemorrhage development. Seven of the hemorrhages developed in patients with ventriculostomies (intraparenchymal, n=4; subdural hematoma, n=3). Three patients who did not receive a ventriculostomy also developed intracranial hemorrhage (n=1) or intraparenchymal hemorrhage (n=2). Hemorrhagic transformation in the recently infarcted brain tissue seemed to be the cause of nonventriculostomy related intraparenchymal hemorrhage. The hemorrhages were accompanied by symptomatic aggravation in 6 of 10 cases, with 5 cases resulting in moribund clinical outcome.


CONCLUSIONS
Postprocedural intracranial hemorrhage may be a risk of stent-remodeled therapy while the patient is on dual-antiplatelet medication. Extra caution is warranted especially in patients with acute subarachnoid hemorrhage requiring ventriculostomy or with underlying recent brain infarction.
Kim
Dong Joon
DJ
Department of Radiology, Research Institute of Radiological Sciences, Yonsei University College of Medicine, Seoul, Korea.
Suh
Sang Hyun
SH
Kim
Byung Moon
BM
Kim
Dong Ik
DI
Huh
Seung Kon
SK
Lee
Jae Whan
JW
D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011859:Radiography; D015607:Stents / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy