Skip to main content

Advertisement

SpringerLink
Log in

Symptomatic periprocedural intracranial hemorrhage unrelated to coil embolization in 1287 patients with intracranial aneurysms

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

Periprocedural symptomatic intracranial hemorrhage (sICH) unrelated to coil embolization of intracranial aneurysm has been rarely reported. The incidence and characteristics of this complication remain unclear. This study was designed to elucidate the incidence and characteristics of periprocedural sICH unrelated to coiling of intracranial aneurysm, and to explore the possible mechanisms underlying this complication.

Methods

Included in this retrospective study were 1287 patients with 1394 aneurysms who were treated with coil embolization (476 patients with stent assistance and 811 patients without stents) between May 2008 and August 2017. All procedure-unrelated sICHs that occurred within 30 days after coiling were selected. The technical details of the procedure, clinical characteristics, and medical therapy were recorded.

Results

A total of 6 patients developed periprocedural sICH unrelated to coil embolization. All these six patients underwent stent-assisted coiling (SAC). Therefore, there was a 1.3% (6/476) procedure-unrelated sICH rate of SAC and 0% (0/811) in patients underwent coiling without stent during the periprocedural period (P = 0.005, RR 0.987; 95% CI, 0.977–0.997). These phenomena occurred more often in patients who received SAC for ruptured aneurysms vs patients underwent this technique for unruptured aneurysms (2.0 vs 0.7%, P = 0.390, RR 2.896; 95% CI, 0.525–15.968). All these phenomena occurred within 7 days after coiling, and resulted in one mortality, one unfavorable outcome (mRS Score 3), and other four favorable outcomes (mRS Scores 0–2) at 90 days after procedure.

Conclusion

Our findings suggest that the procedure-unrelated sICH, though less frequent, may exist following stent-assisted coiling of intracranial aneurysm during the periprocedural period. Extra caution may be warranted in patients who were treated with SAC for ruptured aneurysms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

aSAH:

Aneurysmal subarachnoid hemorrhage

CT:

Computed tomography

DAPT:

Dual-antiplatelet therapy

IPH:

Intraparenchymal hemorrhage

sICH:

Symptomatic intracranial hemorrhage

References

  1. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360(9342):1267–1274

    Article  PubMed  Google Scholar 

  2. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817

    Article  PubMed  Google Scholar 

  3. Brisman JL, Niimi Y, Song JK, Berenstein A (2005) Aneurysmal rupture during coiling: low incidence and good outcomes at a single large volume center. Neurosurgery 57:1103–1109

    Article  PubMed  Google Scholar 

  4. Grunwald IQ, Papanagiotou P, Politi M, Struffert T, Roth C, Reith W (2006) Endovascular treatment of unruptured intracranial aneurysms: occurrence of thromboembolic events. Neurosurgery 58:612–618. https://doi.org/10.1227/01.NEU.0000204101.00996.D9

    Article  PubMed  Google Scholar 

  5. Pierot L, Cognard C, Anxionnat R, Ricolfi F, Investigators CLARITY (2010) Ruptured intracranial aneurysms: factors affecting the rate and outcome of endovascular treatment complications in a series of 782 patients (CLARITY study). Radiology 256:916–923. https://doi.org/10.1148/radiol.10092209

    Article  PubMed  Google Scholar 

  6. Ricolfi F, Le Guerinel C, Blustajn J, Combes C, Brugieres P, Melon E, Gaston A (1998) Rupture during treatment of recently ruptured aneurysms with Guglielmi electrodetachable coils. Am J Neuroradiol 19:1653–1658

    PubMed  CAS  Google Scholar 

  7. Sluzewski M, Bosch JA, van Rooij WJ, Nijssen PC, Wijnalda D (2001) Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors. J Neurosurg 94:238–240. https://doi.org/10.3171/jns.2001.94.2.0238

    Article  PubMed  CAS  Google Scholar 

  8. He J, Whelton PK, Vu B, Klag MJ (1998) Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. JAMA 280:1930–1935

    Article  PubMed  CAS  Google Scholar 

  9. CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329–1339

    Article  Google Scholar 

  10. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ, investigators MATCH (2004) Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebocontrolled trial. Lancet 364:331–337

    Article  PubMed  CAS  Google Scholar 

  11. Kim DJ, Suh SH, Kim BM, Kim DI, Huh SK, Lee JW (2010) Hemorrhagic complications related to the stent- remodeled coil embolization of intracranial aneurysms. Neurosurgery 67(1):73–78

    Article  PubMed  Google Scholar 

  12. Chung J, Lim YC, Suh SH, Shim YS, Kim YB, Joo JY, Kim BS, Shin YS (2014) Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications. J Neurosurg 121(1):4–11

    Article  PubMed  Google Scholar 

  13. Tumialan LM et al (2008) Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: a cautionary report. J Neurosurg 108(6):1122–1129

    Article  PubMed  Google Scholar 

  14. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9

    Article  PubMed  CAS  Google Scholar 

  15. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352(9136):1245–1251

    Article  PubMed  CAS  Google Scholar 

  16. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: practical scale. Lancet 1(7905):480–484

    Article  PubMed  CAS  Google Scholar 

  17. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 4:1398–1403

    Article  Google Scholar 

  18. Gallas S, Pasco A, Cottier JP, Gabrillargues J, Drouineau J, Cognard C, Herbreteau D (2005) A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 26(7):1723–1731

    PubMed  Google Scholar 

  19. Lee M, Saver JL, Hong KS, Rao NM, Wu YL, Ovbiagele B (2013) Risk-benefit profile of long-term dual- versus single-antiplatelet therapy among patients with ischemic stroke: a systematic review and meta-analysis. Ann Intern Med 159(7):463–470

    Article  PubMed  Google Scholar 

  20. Wang Y, Johnston SC, Wang Y (2013) Clopidogrel with aspirin in minor stroke or transient ischemic attack. N Engl J Med 369(14):1376–1387

    PubMed  CAS  Google Scholar 

  21. Keep RF, Andjelkovic AV, Stamatovic SM, Shakui P, Ennis SR (2005) Ischemia-induced endothelial cell dysfunction. Acta Neurochir Suppl 95:399–402

    Article  PubMed  CAS  Google Scholar 

  22. Velat GJ, Fargen KM, Lawson MF, Hoh BL, Fiorella D, Mocco J (2012) Delayed intraparenchymal hemorrhage following pipeline embolization device treatment for a giant recanalized ophthalmic aneurysm. J Neurointerv Surg 4(5):e24. https://doi.org/10.1136/neurintsurg-2011-010129

    Article  PubMed  Google Scholar 

  23. Cruz JP, Chow M, O’Kelly C et al (2012) Delayed ipsilateral parenchymal hemorrhage following flow diversion for the treatment of anterior circulation aneurysms. Am J Neuroradiol 33:603–608

    Article  PubMed  CAS  Google Scholar 

  24. Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF (2013) Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke 44(2):442–447

    Article  PubMed  Google Scholar 

  25. Goh C, Churilov L, Mitchell P, Dowling R, Yan B (2013) Clopidogrel hyper-response and bleeding risk in neurointerventional procedures. Am J Neuroradiol 34(4):721–726

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Author notes

  1. HX and LW contributed equally to this study and share senior authorship.

Authors and Affiliations

  1. Department of Neurointerventional Radiology, The First Affiliated Hospital of Zhengzhou University, Road Jianshe No 1, Zhengzhou City, 450052, China

    Haowen Xu, Sheng Guan, Dongdong Li & Tao Quan

  2. Department of Neurology, Children Hospital of Zhengzhou City, Zhengzhou City, China

    Li Wang

Authors
  1. Haowen Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sheng Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dongdong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tao Quan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tao Quan.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the the medical ethics committee of the First Affiliated Hospital of Zhengzhou University, China, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, H., Wang, L., Guan, S. et al. Symptomatic periprocedural intracranial hemorrhage unrelated to coil embolization in 1287 patients with intracranial aneurysms. Neuroradiology 60, 853–859 (2018). https://doi.org/10.1007/s00234-018-2049-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-018-2049-6

Keywords

Search

Navigation