Document Detail


Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: a cautionary report.
MedLine Citation:
PMID:  18518714     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The introduction of the Neuroform microstent has facilitated the embolization of complex cerebral aneurysms, which were previously not amenable to endovascular therapy. Typically, the use of this stent necessitates the administration of dual antiplatelet therapy to minimize thromboembolic complications. Such therapy may increase the risk of hemorrhage in patients who require concurrent external ventricular drainage and/or subsequent permanent cerebrospinal fluid diversion. METHODS: The authors' neurosurgical database was queried for all patients who underwent stent-assisted coil embolization for cerebral aneurysms and who required an external ventricular drain (EVD) or ventriculoperitoneal (VP) shunt placement for management of hydrocephalus. RESULTS: Thirty-seven patients underwent stent-assisted coil embolization for intracranial aneurysms at the authors' institution over a recent 2-year period. Seven of these patients required placement of an EVD and/or a VP shunt. Three of the 7 patients suffered an immediate intraventricular hemorrhage (IVH) associated with placement or manipulation of an EVD; 1 experienced a delayed intraparenchymal hemorrhage and an IVH; 1 suffered an aneurysmal rehemorrhage; and the last patient had a subdural hematoma (SDH) that resulted from placement of a VP shunt. This patient required drainage of the SDH and exchange of the valve. CONCLUSIONS: The necessity of dual antiplatelet therapy in the use of stent-assisted coil embolization increases the risk of intracranial hemorrhage and possibly rebleeding from a ruptured aneurysm. This heightened risk must be recognized when contemplating the appropriate therapy for a cerebral aneurysm and when considering the placement or manipulation of a ventricular catheter in a patient receiving dual antiplatelet therapy. Further study of intracranial procedures in patients receiving dual antiplatelet therapy is indicated.
Authors:
Luis M Tumialán; Y Jonathan Zhang; C Michael Cawley; Jacques E Dion; Frank C Tong; Daniel L Barrow
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  108     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-07-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1122-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cerebrospinal Fluid Shunts / adverse effects
Cohort Studies
Embolization, Therapeutic / adverse effects*,  instrumentation*
Female
Humans
Intracranial Aneurysm / complications,  diagnosis,  therapy*
Intracranial Hemorrhages / diagnosis,  etiology*,  therapy
Male
Middle Aged
Platelet Aggregation Inhibitors / adverse effects
Retrospective Studies
Stents / adverse effects*
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors
Comments/Corrections
Comment In:
J Neurosurg. 2008 Jun;108(6):1119-21   [PMID:  18518713 ]

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