title: Ischemic Stroke After Treatment of Intraprocedural Thrombosis During Stent-Assisted Coiling and Flow Diversion.
abstract: Intraprocedural thrombosis poses a formidable challenge during neuroendovascular procedures because the risks of aggressive thromboembolic treatment must be balanced against the risk of postprocedural hemorrhage. The aim of this study was to identify predictors of ischemic stroke after intraprocedural thrombosis after stent-assisted coiling and pipeline embolization device placement.
  
  
  
  A retrospective analysis of intracranial aneurysms treated with stent-assisted coiling or pipeline embolization device placement between 2007 and 2016 at 4 major academic institutions was performed to identify procedures that were complicated by intraprocedural thrombosis.
  
  
  
  Intraprocedural thrombosis occurred in 34 (4.6%) procedures. Postprocedural ischemic stroke and hemorrhage occurred in 20.6% (7/34) and 11.8% (4/34) of procedures complicated by intraprocedural thrombosis, respectively. Current smoking was an independent predictor of ischemic stroke. There was no statistically significant difference in the rate of ischemic stroke or postprocedural hemorrhage with the use of abciximab compared with the use of eptifibatide in treatment of intraprocedural thrombosis.
  
  
  
  Current protocols for treatment of intraprocedural thrombosis associated with placement of intra-arterial devices were effective in preventing ischemic stroke in ≈80% of cases. Current smoking was the only independent predictor of ischemic stroke.
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Nimer
authors.initials: N
authors.lastname: Adeeb
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Justin M
authors.initials: JM
authors.lastname: Moore
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Hussain
authors.initials: H
authors.lastname: Shallwani
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Rouzbeh
authors.initials: R
authors.lastname: Motiei-Langroudi
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Raghav
authors.initials: R
authors.lastname: Gupta
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Baccin
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Alturki
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.).
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: From the Neurosurgical Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., R.G., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.); and Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.E.B.). athomas6@bidmc.harvard.edu.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
mesh_terms: D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000379:methods* / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006401:Hematologic Agents / Q000627:therapeutic use*; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006401:Hematologic Agents; D010975:Platelet Aggregation Inhibitors
keywords: abciximab; aneurysm; coiling; complications; eptifibatide; intraprocedural; pipeline; stent-assisted; thromboembolic