Document Detail


Thromboembolic Complications After Neuroform™ Stent Assisted Treatment of Cerebral Aneurysms: The Duke Cerebrovascular Center Experience in 235 Patients with 274 Stents.
MedLine Citation:
PMID:  21499154     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: The Neuroform™ Stent has facilitated the endovascular treatment of wide-necked cerebral aneurysms. It is unknown which factors pose risks of thromboembolic events following stent placement. Objective: This series is the largest single-center study reporting on incidence of and factors influencing thromboembolic complications following Neuroform™ stent placement. METHODS:: 235 patients were treated with 274 Neuroform™ stents. Thromboembolic event rate was determined by imaging or clinical evidence of cerebrovascular accident within 90 days of stent placement; for patients with incomplete follow-up through chart review, telephone interviews were conducted. Analyses were performed to investigate patient factors that may be associated with stroke. RESULTS:: MOST ANEURYSMS WERE UNRUPTURED; 30 PATIENTS (12.8%) PRESENTED WITH ACUTE SUBARACHNOID HEMORRHAGE. 12 PATIENTS OF THE 224 WITH FOLLOW-UP (5.4 %, 95% CI 2.4-8.3%) DEMONSTRATED IMAGING OR CLINICAL EVIDENCE OF NEW THROMBOEMBOLIC EVENT WITHIN 90 DAYS OF STENT PLACEMENT. THERE WAS A 3.1% THROMBOEMBOLIC RATE FOR NON-RUPTURED ANEURYSMS AND A 20% RATE IN PATIENTS WITH SUBARACHNOID BLEED. HEMORRHAGE WAS SIGNIFICANTLY ASSOCIATED WITH HAVING A THROMBOEMBOLIC EVENT (P=0.002). THERE WAS A TREND TOWARD INCREASED THROMBOEMBOLIC EVENT RATE FOR PATIENTS WITH HYPERTENSION (P=0.07). LARGER STENT CALIBER WAS SIGNIFICANTLY ASSOCIATED WITH DECREASED THROMBOEMBOLIC EVENT RATE (P=0.032). CONCLUSIONS:: Our results suggest the thromboembolic event rate associated with Neuroform™ stent use is low in unruptured aneurysms. In ruptured aneurysms, complication rate is high, possibly partly related to restricted use of anti-platelet therapy. Stent size and hypertension may be associated with risk of stroke, but additional studies are needed to confirm their significance.
Authors:
Mark L Lessne; Pratish Shah; Michael J Alexander; Huiman X Barnhart; Ciaran Powers; Kiarash Golshani; Andrew Ferrell; David Enterline; Ali Zomorodi; Tony Smith; Gavin W Britz
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-14
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Department of Radiology, Division of Neurointerventional Radiology, Duke University Medical Center, Durham, NC 27710, USA, 2 Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA, 3 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA, 4 Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA, Financial and Material Support: None.
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