Top

Published in:

01-06-2019 | Ruptured Aneurysm | Original Article - Vascular Neurosurgery - Aneurysm

Association between extracranial internal carotid artery tortuosity and thromboembolic complications during coil embolization of anterior circulation ruptured aneurysms

Authors: Atsushi Ogata, Kenji Suzuyama, Ryo Ebashi, Yukinori Takase, Kohei Inoue, Jun Masuoka, Fumitaka Yoshioka, Yukiko Nakahara, Tatsuya Abe

Published in: Acta Neurochirurgica | Issue 6/2019

Abstract

Background

The most frequent neurological complication during coil embolization of a ruptured cerebral aneurysm is a thromboembolic event. The association between the tortuosity of the internal carotid artery (ICA) and thromboembolic events (TEEs) during coil embolization of ruptured cerebral aneurysms remains unclear. The present study aimed to investigate the association between extracranial ICA tortuosity and thromboembolic complications during coil embolization of anterior circulation ruptured aneurysms.

Methods

A cohort of 57 patients with 57 anterior circulation ruptured aneurysms who underwent endovascular embolization at a single institution was retrospectively investigated. Patients were divided into two groups, those who experienced TEEs and those who did not that were compared and analyzed based on patient baseline characteristics, procedural factors, and anatomical factors including those of aneurysms and extracranial ICA tortuosity. The anatomical factors of the aneurysms included maximum dome size, neck width, dome-to-neck ratio, and dome-to-neck aspect ratio. Extracranial ICA angles in the proximal and distal curvature were evaluated as ICA tortuosity.

Results

Three of the 57 patients were excluded because of unavailability of data regarding ICA tortuosity; 54 patients were finally evaluated. TEEs occurred in six patients with five anterior cerebral and one internal carotid aneurysms. The extracranial distal ICA angle was significantly larger in patients with TEEs than in those without. Procedural factors and anatomical factors of the aneurysms were not associated with TEEs.

Conclusions

Extracranial ICA tortuosity was significantly associated with an increased incidence of thromboembolic events during endovascular coiling of anterior circulation ruptured aneurysms.

Edwards NJ, Jones WH, Sanzgiri A, Corona J, Dannenbaum M, Chen PR (2017) Antiplatelet therapy for the prevention of peri-coiling thromboembolism in high-risk patients with ruptured intracranial aneurysms. J Neurosurg 127:1326–1332. https://doi.org/10.3171/2016.9.JNS161340 CrossRefPubMed

Fiehler J, Ries T (2009) Prevention and treatment of thromboembolism during endovascular aneurysm therapy. Klin Neuroradiol 19:73–81. https://doi.org/10.1007/s00062-009-8029-9 CrossRefPubMed

Fukuda H, Handa A, Koyanagi M, Yoshida K, Lo BW, Yamagata S (2015) Endovascular therapy for ruptured cerebral aneurysms in the elderly: poor accessibility of the guiding catheter and use of local anesthesia as the predictors of procedure-related rupture. Neurosurgery 77:544–552; discussion 552. https://doi.org/10.1227/NEU.0000000000000874 CrossRefPubMed

Fukuda H, Handa A, Koyanagi M, Lo B, Yamagata S (2018) Association of plasma D-dimer level with thromboembolic events after endovascular coil treatment of ruptured cerebral aneurysms. J Neurosurg 1:1–8. https://doi.org/10.3171/2017.7.JNS171129 CrossRef

Machino-Ohtsuka T, Seo Y, Ishizu T, Sekiguchi Y, Sato A, Tada H, Watanabe S, Aonuma K (2010) Combined assessment of carotid vulnerable plaque, renal insufficiency, eosinophilia, and hs-CRP for predicting risky aortic plaque of cholesterol crystal embolism. Circ J 74:51–58CrossRefPubMed

Montaner J, Perea-Gainza M, Delgado P, Ribo M, Chacon P, Rosell A, Quintana M, Palacios ME, Molina CA, Alvarez-Sabin J (2008) Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers. Stroke 39:2280–2287. https://doi.org/10.1161/strokeaha.107.505354 CrossRefPubMed

Muller MD, Ahlhelm FJ, von Hessling A, Doig D, Nederkoorn PJ, Macdonald S, Lyrer PA, van der Lugt A, Hendrikse J, Stippich C, van der Worp HB, Richards T, Brown MM, Engelter ST, Bonati LH (2017) Vascular anatomy predicts the risk of cerebral ischemia in patients randomized to carotid stenting versus endarterectomy. Stroke 48:1285–1292. https://doi.org/10.1161/STROKEAHA.116.014612 CrossRefPubMed

Ogasawara K, Suga Y, Sasaki M, Chida K, Kobayashi M, Yoshida K, Otawara Y, Ogawa A (2008) Intraoperative microemboli and low middle cerebral artery blood flow velocity are additive in predicting development of cerebral ischemic events after carotid endarterectomy. Stroke 39:3088–3091. https://doi.org/10.1161/STROKEAHA.107.511360 CrossRefPubMed

Orlandi G, Fanucchi S, Gallerini S, Sonnoli C, Cosottini M, Puglioli M, Sartucci F, Murri L (2005) Impaired clearance of microemboli and cerebrovascular symptoms during carotid stenting procedures. Arch Neurol 62:1208–1211. https://doi.org/10.1001/archneur.62.8.1208 CrossRefPubMed

10.

Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, Kassam A (2005) Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:506–514PubMed

11.

Ries T, Buhk JH, Kucinski T, Goebell E, Grzyska U, Zeumer H, Fiehler J (2006) Intravenous administration of acetylsalicylic acid during endovascular treatment of cerebral aneurysms reduces the rate of thromboembolic events. Stroke 37:1816–1821. https://doi.org/10.1161/01.STR.0000226933.44962.a6 CrossRefPubMed

12.

Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004CrossRefPubMed

13.

Yoon CH, Lee HW, Kim YS, Lee SW, Yeom JA, Roh J, Baik SK (2018) Preliminary study of tirofiban infusion in coil embolization of ruptured intracranial aneurysms. Neurosurgery 82:76–84. https://doi.org/10.1093/neuros/nyx177 CrossRefPubMed

Title: Association between extracranial internal carotid artery tortuosity and thromboembolic complications during coil embolization of anterior circulation ruptured aneurysms
Authors: Atsushi Ogata
Kenji Suzuyama
Ryo Ebashi
Yukinori Takase
Kohei Inoue
Jun Masuoka
Fumitaka Yoshioka
Yukiko Nakahara
Tatsuya Abe
Publication date: 01-06-2019
Publisher: Springer Vienna
Keywords: Ruptured Aneurysm
Aneurysm
Aneurysm
Published in: Acta Neurochirurgica / Issue 6/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-019-03903-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between extracranial internal carotid artery tortuosity and thromboembolic complications during coil embolization of anterior circulation ruptured aneurysms

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2019

Univariate comparison of performance of different cerebrovascular reactivity indices for outcome association in adult TBI: a CENTER-TBI study

The “Friday peak” in surgical referrals for spinal metastases: lessons not learned. A retrospective analysis of 201 consecutive cases at a tertiary center

Turkey loses one of the pioneers of microneurosurgery and a great scientific leader

Manual for clinical language tractography

Lipomatosis of nerve and overgrowth syndrome: an intriguing and still unclear correlation

Brain biopsy in suspected non-neoplastic neurological disease