Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Cerebrovascular events like ischemic stroke and transient ischemic attack (TIA) can occur post-treatment of intracranial aneurysms using Guglielmi detachable coils (GDCs).
• Identifying risk factors and understanding the temporal pattern of these thromboembolic events is crucial for patient safety and procedural optimization.

Purpose of the Study:

• To investigate potential risk factors associated with thromboembolic events following GDC treatment for intracranial aneurysms.
• To determine the frequency and time course of these post-procedure ischemic events.

Main Methods:

• Retrospective review of 178 patients with 193 treated intracranial saccular aneurysms.
• Analysis of 159 GDC procedures in 133 patients with good neurological status to detect clinical ischemic events.
• Uni- and multivariate analyses to assess associations between clinical, anatomical, and pharmacological factors and thromboembolic events.

Main Results:

• Intra-arterial thrombus occurred in 6 of 159 procedures, causing a deficit in one patient.
• Ten post-procedure ischemic events (TIA or stroke) occurred in nine patients, with seven within 24 hours and three between 24 hours and 58 days.
• Aneurysm diameter and protruding coils were significant independent predictors of post-procedure ischemic events (p=0.02); the actuarial risk of stroke was 3.8%.

Conclusions:

• Increased aneurysm diameter and protruding coil loops are significantly associated with post-procedure ischemic events after GDC placement.
• The thromboembolic potential of GDC-treated aneurysms appears to decrease significantly beyond two months post-procedure.