Heparin dosing is associated with diffusion weighted imaging lesion load following aneurysm coiling.
OBJECTIVE
Diffusion weighted imaging (DWI) may be used to evaluate post-coiling ischemia. Heparinization protocols for cerebral aneurysm coiling procedures differ among operators and centers, with little literature surrounding its effect on DWI lesions. The goal of this study was to determine which factors, including heparinization protocols, may affect DWI lesion load post-coiling.


METHODS
A review of 135 coiling procedures over 5 years at our centre was performed. Procedural data including length of procedure, number of coils used, stent or balloon assistance and operators were collected. Procedures were either assigned as using a bolus dose (>2000 U at any one time) or small aliquots of heparin (≤2000 U). Postprocedure DWI was reviewed and lesions were classified as small (< 5mm), medium (5-10 mm) or large (>10 mm). The cases were then classified into group 1 (≤5 small lesions) or group 2 (>5 small lesions or ≥1 medium or large lesion). Multivariate regression of the procedural variables for the two groups was calculated. A p value of <0.05 was considered significant.


RESULTS
There were 78 procedures in group 1 and 57 procedures in group 2. Patients who received small aliquots (n=37) versus boluses of heparin (n=98) intraprocedurally had significantly greater frequency and size of DWI lesions (p=0.03). None of the other procedural variables was found to impact on lesion load.


CONCLUSIONS
More substantial DWI lesions were associated with small aliquots of heparin dosage compared with bolus doses. Heparin boluses should be preferentially administered during aneurysm coiling.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Mary Jane
MJ
Lim Fat
Mohammed
M
Al-Hazzaa
Miguel
M
Bussière
Marlise P
MP
dos Santos
Howard
H
Lesiuk
Cheemun
C
Lum
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents
D006493:Heparin