title: Microembolism after endovascular coiling of unruptured cerebral aneurysms: incidence and risk factors.
abstract: OBJECTIVE
  The incidence and risk factors of microembolic lesions on MR diffusion-weighted imaging (DWI) were analyzed after the endovascular coiling of unruptured intracranial aneurysms (UIAs).
  
  
  METHODS
  Data obtained from 271 consecutive patients (70 men and 201 women; median age 57 years; range 23-79 years) who presented with UIA for coil embolization between July 2011 and June 2013 were analyzed. Two independent reviewers examined the DWI and apparent diffusion coefficient maps obtained the following day for the presence of restrictive diffusion spots and counted the number of spots. Multivariate analysis was then performed to identify independent risk factors for developing microembolism following the coiling of an aneurysm.
  
  
  RESULTS
  Microembolic lesions were noted in 101 of 271 patients (37.3%). The results of the multivariate analysis showed that the following factors significantly influenced the risk for microembolism: age, diabetes, previous history of ischemic stroke, high-signal FLAIR lesions in the white matter, multiple aneurysms, and the insertion of an Enterprise stent (all ORs > 1.0 and all p values < 0.05). Previously known risk factors such as prolonged procedure duration, aneurysm size, and decreased antiplatelet function did not show any significant influence.
  
  
  CONCLUSIONS
  The incidence of microembolism after endovascular coiling of UIA was not low. Lesions occurred more frequently in patients with vascular status associated with old age, diabetes, and previous stroke. Aneurysm multiplicity and the type of stent used for treatment also influenced lesion occurrence.
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Jung Cheol
authors.initials: JC
authors.lastname: Park
authors.affiliation: Radiology, Asan Medical Center, University of Ulsan College of Medicine; and.
authors.forename: Deok Hee
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Jae Kyun
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Byung Duk
authors.initials: BD
authors.lastname: Kwun
authors.affiliation: Radiology, Asan Medical Center, University of Ulsan College of Medicine; and.
authors.forename: Dae Yoon
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Radiology, Asan Medical Center, University of Ulsan College of Medicine; and.
authors.forename: Choong Gon
authors.initials: CG
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000628:therapy*; D020766:Intracranial Embolism / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACT = activated clotting time; ADC = apparent diffusion coefficient; BMI = body mass index; DM = diabetes mellitus; DWI = diffusion-weighted imaging; HSI = high signal intensity; PRU = P2Y12 reaction unit; UIA= unruptured intracranial aneurysm; diffusion-weighted imaging; endovascular coiling; microembolism; unruptured cerebral aneurysm; vascular disorders