Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases.
OBJECTIVE
New ischemic brain lesions are common findings after cerebral diagnostic angiography and endovascular therapy. Diffusion-weighted MRI (DWI) can be used for detection of these lesions. The aim of the present study was to investigate the incidence of DWI lesions after stent-assisted coiling and the evaluation of possible risk factors.


METHODS
The study included a total of 75 consecutive patients treated with stent-assisted coiling. Post-procedural DWI of the brain was performed to detect ischemic lesions. Demographic data, aneurysm characteristics and angiographic parameters were correlated with properties of DWI lesions.


RESULTS
In post-procedural DWI, 48 of the 75 patients (64%) had 163 DWI lesions in a pattern consistent with embolic events. The number of patients with DWI lesions was significantly increased in older patients (≥55 years) and longer intervention times (≥120 min). The ischemic brain volume was significantly increased in older patients (≥55 years) as well as in patients who were implanted with a shorter stent (<20 mm).


CONCLUSIONS
Thromboembolic events are common after stent-assisted coiling with an incidence comparable to DWI studies after coiling alone. Despite several devices and low operator experience, stent-assisted coiling for intracranial aneurysms has a very low risk of permanent neurologic disability. Further studies are necessary to improve the safety of stent-assisted coiling for patients in conditions with increased risk potential (age, procedure time, stent length).
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany.
M L
ML
Hahnemann
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany.
A
A
Ringelstein
Department of Neurosurgery, University Hospital Essen, Essen, NRW, Germany.
I E
IE
Sandalcioglu
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany.
S
S
Goericke
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany.
C
C
Moenninghoff
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany Department of Neuroradiology, Clinic Hirslanden, Zürich, Switzerland.
I
I
Wanke
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany.
M
M
Forsting
Department of Neurosurgery, University Hospital Essen, Essen, NRW, Germany.
U
U
Sure
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany.
M
M
Schlamann
D000328:Adult; D000367:Age Factors; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000601:surgery*; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*
Aneurysm; Coil; Stent