title: Stent-assisted coiling of wide-necked aneurysms in the setting of acute subarachnoid hemorrhage:  experience in 65 patients.
abstract: BACKGROUND
  Stent-assisted coiling in the setting of subarachnoid hemorrhage remains controversial. Currently, there is a paucity of data regarding the utility of this procedure and the risks of hemorrhagic and ischemic complications.
  
  
  OBJECTIVE
  To assess the utility of stent-assisted coil embolization and pretreatment with antiplatelet agents in the management of ruptured wide-necked aneurysms.
  
  
  METHODS
  A retrospective study of 65 patients with ruptured wide-necked aneurysms treated with stent-assisted coiling. Patients with hydrocephalus or a Hunt and Hess grade ≥ III received a ventriculostomy before endovascular intervention. Patients were treated intraoperatively with 600 mg of clopidogrel and maintained on daily doses of 75 mg of clopidogrel and 81 mg of aspirin. The Glasgow outcome scale (GOS) score was recorded at the time of discharge. We identified major bleeding complications secondary to antiplatelet therapy and cases of in-stent thrombosis that required periprocedural thrombolysis.
  
  
  RESULTS
  Of the aneurysms, 66.2% arose within the anterior circulation; 69.2% of patients presented with hydrocephalus or a Hunt and Hess grade ≥ III and required a ventriculostomy. A good outcome (GOS of 4 or 5) was achieved in 63.1% of patients, and the overall mortality rate was 16.9%. There were 10 (15.38%) major complications associated with bleeding secondary to antiplatelet therapy (5 patients, 7.7%) or intraoperative in-stent thrombosis (5 patients, 7.7%). Three (4.6%) patients had a fatal hemorrhage.
  
  
  CONCLUSIONS
  Our findings suggest that stent-assisted coiling and routine treatment with antiplatelet agents is a viable option in the management of ruptured wide-necked aneurysms.
authors.affiliation: Department of Neurological Surgery, Division of Vascular Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Amenta
authors.forename: Richard T
authors.initials: RT
authors.lastname: Dalyai
authors.forename: David
authors.initials: D
authors.lastname: Kung
authors.forename: Amy
authors.initials: A
authors.lastname: Toporowski
authors.forename: Sid
authors.initials: S
authors.lastname: Chandela
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Stavropoula I
authors.initials: SI
authors.lastname: Tjoumakaris
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D000077144:Clopidogrel; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine