title: Hemorrhagic Complications Associated with Ventriculostomy in Patients Undergoing Endovascular Treatment for Intracranial Aneurysms: A Single-Center Experience.
abstract: BACKGROUND
  Currently, a complete understanding of post-ventriculostomy hemorrhagic complications in subarachnoid hemorrhage due to ruptured aneurysms remains unknown. The present study evaluates the impact of periprocedural risk factors on rates of external ventricular drain (EVD)-associated hemorrhage in the setting of endovascular treatment of intracranial aneurysms.
  
  
  METHODS
  A retrospective chart review of 107 patients who underwent EVD placement within 24 h of endovascular coiling was performed. CT of head without contrast was obtained after drain placement and before endovascular treatment. Post-procedural CT was also obtained within 48 h of embolization and was reviewed for new/worsened track hemorrhages. Chi-squared test was used in evaluation.
  
  
  RESULTS
  Ninety-three of the 107 patients reviewed met the inclusion criteria. Four (25%) of the 16 patients on antiplatelet medications at presentation experienced post-EVD hemorrhage compared to 11 (14.3%) of 77 that were not (p = 0.29). Of the 13 patients given intraprocedural antiplatelets, 3 (23.1%) demonstrated hemorrhage compared to 12 (15%) of 80 not administered these medications (p = 0.46). Further, of 36 patients with intraprocedural anticoagulation, 6 (16.7%) exhibited hemorrhage compared to 9 (15.8%) of 57 in those without (p = 0.91). In 17 patients who received DVT prophylaxis, 2 (11.8%) exhibited hemorrhage compared to 13 (17.1%) of 76 who did not (p = 0.59). No post-EVD hemorrhage had attributable neurologic morbidity.
  
  
  CONCLUSIONS
  Our results, demonstrating no significant risk factor related to EVD-associated hemorrhage rates, support the safety of EVD placement in the peri-endovascular treatment period.
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Leschke
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lozen
authors.affiliation: Department of Biomedical Engineering, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI, 53233, USA. mayank.kaushal@marquette.edu.
authors.forename: Mayank
authors.identifier: http://orcid.org/0000-0002-4121-6751
authors.initials: M
authors.lastname: Kaushal
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Akinwunmi
authors.initials: A
authors.lastname: Oni-Orisan
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Mazen
authors.initials: M
authors.lastname: Noufal
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Osama
authors.initials: O
authors.lastname: Zaidat
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Pollock
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Wade M
authors.initials: WM
authors.lastname: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014696:Ventriculostomy / Q000009:adverse effects*
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Endovascular treatment; External ventricular drain; Intracranial aneurysm; Subarachnoid hemorrhage; Ventriculostomy