title: Thromboembolic events associated with single balloon-, double balloon-, and stent-assisted coil embolization of asymptomatic unruptured cerebral aneurysms: evaluation with diffusion-weighted MR imaging.
abstract: BACKGROUND
  The introduction of the balloon remodeling and stent-assisted technique has revolutionized the approach to coil embolization for wide-neck aneurysms. The purpose of this study was to determine the frequency of thromboembolic events associated with single balloon-assisted, double balloon-assisted, and stent-assisted coil embolization for asymptomatic unruptured aneurysms.
  
  
  METHODS
  A retrospective review was undertaken by 119 patients undergoing coiling with an adjunctive technique for unruptured saccular aneurysms (64 single balloon, 12 double balloon, 43 stent assisted). All underwent diffusion-weighted imaging (DWI) within 24 h after the procedure.
  
  
  RESULTS
  DWI showed hyperintense lesions in 48 (40%) patients, and ten (21%) of these patients incurred neurological deterioration (permanent, two; transient, eight). Hyperintense lesions were detected significantly more often in procedures with the double balloon-assisted technique (7/12, 58%) than with the single balloon-assisted technique (16/64, 25%, p = 0.05). Occurrence of new lesions was significantly higher with the use of stent-assisted technique (25/43, 58%) than with the single balloon-assisted technique (p = 0.001). Symptomatic ischemic rates were similar between the three groups. The increased number of microcatheters was significantly related to the DWI abnormalities (two microcatheters, 15/63 (23.8%); three microcatheters, 20/41 (48.8%) (p = 0.008); four microcatheters, 12/15 (80%) (p = 0.001)).
  
  
  CONCLUSIONS
  Thromboembolic events detected on DWI related to coil embolization for unruptured aneurysms are relatively common, especially in association with the double balloon-assisted and stent-assisted techniques. Furthermore, the number of microcatheters is highly correlated with DWI abnormalities. The high rate of thromboembolic events suggests the need for evaluation of platelet reactivity and the addition or change of antiplatelet agents.
authors.affiliation: Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan, tomojy33@yahoo.co.jp.
authors.forename: Tomoji
authors.initials: T
authors.lastname: Takigawa
authors.forename: Kensuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sugiura
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Suzuki
authors.forename: Issei
authors.initials: I
authors.lastname: Takano
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shimizu
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Akio
authors.initials: A
authors.lastname: Hyodo
mesh_terms: D038524:Diffusion Magnetic Resonance Imaging; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012189:Retrospective Studies; D015607:Stents; D013923:Thromboembolism / Q000209:etiology*