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01-12-2014 | Interventional Neuroradiology

Thromboembolic events associated with single balloon-, double balloon-, and stent-assisted coil embolization of asymptomatic unruptured cerebral aneurysms: evaluation with diffusion-weighted MR imaging

Authors: Tomoji Takigawa, Kensuke Suzuki, Yoshiki Sugiura, Ryotaro Suzuki, Issei Takano, Nobuyuki Shimizu, Yoshihiro Tanaka, Akio Hyodo

Published in: Neuroradiology | Issue 12/2014

Abstract

Introduction

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)).

Conclusion

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.

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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
Authors: Tomoji Takigawa
Kensuke Suzuki
Yoshiki Sugiura
Ryotaro Suzuki
Issei Takano
Nobuyuki Shimizu
Yoshihiro Tanaka
Akio Hyodo
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 12/2014
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-014-1421-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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