title: Microembolic signal monitoring after coiling of unruptured cerebral aneurysms: an observational analysis of 123 cases.
abstract: OBJECTIVE
  Thromboembolic events after aneurysm coiling are common, but the optimal algorithm for emboli prevention remains unclear. MESs correlate with the occurrence of impending ischemic events and may be used for management guidance. This study reports the use of MES monitoring with regard to aneurysm characteristics and coiling technique after a specific anticoagulation protocol.
  
  
  METHODS
  We analyzed 123 consecutive, elective endovascular procedures. Patients received intraprocedural and continuous heparin if feasible. Demographic data, aneurysm size, type of intervention/complication, medication, imaging, and clinical outcome were analyzed. MES monitoring was performed in all patients both immediately after as well as >12 hours after the procedure.
  
  
  RESULTS
  Heparinization within the first 12 hours was associated with lower numbers of MESs early after coiling (3.4 versus 18.8 MESs/hr). When on heparin, larger aneurysm size, stent-assisted procedures, or incomplete occlusion did not lead to a significant increase in MESs. If the initial MES count on heparin was >10 MESs/hr, it was always safe to discontinue heparin. Inability to initiate early, continuous heparinization was associated with new neurologic deficits. Additional administration of antiplatelet agents showed lower MES counts initially, but the difference was not significant.
  
  
  CONCLUSIONS
  MES monitoring is a powerful adjunct to monitor efficacy of treatment algorithms for emboli prevention after coiling. In our series, early heparinization was associated with a lower incidence of MESs. This is of particular importance in larger aneurysms, stent-assisted procedures, and incomplete occlusions, in which the thromboembolic risk is greatest early on and antiplatelet treatment alone may not suffice.
authors.affiliation: Department of Neurosurgery, University of Innsbruck, Austria. gerrit.schubert@gmx.net
authors.forename: G A
authors.initials: GA
authors.lastname: Schubert
authors.forename: C
authors.initials: C
authors.lastname: Thomé
authors.forename: M
authors.initials: M
authors.lastname: Seiz
authors.forename: C
authors.initials: C
authors.lastname: Douville
authors.forename: J
authors.initials: J
authors.lastname: Eskridge
mesh_terms: D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed