title: Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review.
abstract: BACKGROUND
  The purpose of this study is to retrospectively review our experience with stent-assisted embolization of patients with an acutely ruptured cerebral aneurysm.
  
  
  METHODS
  Medical records and imaging were reviewed for 36 patients who underwent stent-assisted embolization of a ruptured cerebral aneurysm.
  
  
  RESULTS
  Seventeen patients (47%) received a preprocedural loading dose of clopidogrel and five patients (14%) received an intraprocedural dose of clopidogrel. The remaining 14 patients (36%) were treated with antiplatelet therapy following the procedure. Six (17%) stent related intraprocedural thromboembolic complications were encountered; four of these resolved (one partial, three complete) following treatment with abciximab and/or heparin during the procedure. Five of the six thromboembolic events occurred in patients who were not pretreated with clopidogrel (P = 0.043). Two patients in this series (6%) had a permanent thrombotic complication resulting in mild hemiparesis in one patient, and hemianopsia in the second. No procedure related hemorrhagic complications occurred in any patient. One patient had a spontaneous parenchymal hemorrhage contralateral to the treated aneurysm discovered 10 days after treatment. Twenty-eight patients (78%) had a Glasgow Outcome Score of 4 or better at discharge. Seven of 21 patients (33%) with angiographic follow-up required further treatment of the coiled aneurysm.
  
  
  CONCLUSIONS
  Stent-assisted coil embolization is an option for treatment of ruptured wide neck ruptured aneurysms and for salvage treatment during unassisted embolization of ruptured aneurysms but complications and retreatment rates are higher than for routine clipping or coiling of cerebral aneurysms. Pretreatment with clopidogrel appears effective in reducing thrombotic complications without significant increasing risk of hemorrhagic complications.
authors.affiliation: Department of Neurological Surgery, Loma Linda University Medical Center, Loma Linda, USA.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Golshani
authors.forename: Andrew
authors.initials: A
authors.lastname: Ferrel
authors.forename: Mark
authors.initials: M
authors.lastname: Lessne
authors.forename: Pratish
authors.initials: P
authors.lastname: Shah
authors.forename: Abhineet
authors.initials: A
authors.lastname: Chowdhary
authors.forename: Armen
authors.initials: A
authors.lastname: Choulakian
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Alexander
authors.forename: Tony P
authors.initials: TP
authors.lastname: Smith
authors.forename: David S
authors.initials: DS
authors.lastname: Enterline
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz