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Types of thromboembolic complications in coil embolization for intracerebral aneurysms and management
Hong-Ki Kim1, Sung-Kyun Hwang, Sung-Hak Kim
1Department of Neurosurgery, School of Medicine, Ewha Womans University, Seoul, Korea.
Insights
Thromboembolic complications during endovascular aneurysm treatment are rare (4.6%). While antiplatelet and thrombolytic agents show limited effectiveness, active interventions like angioplasty and clot extraction offer better outcomes.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Endovascular treatment of cerebral aneurysms is a common procedure.
- Thromboembolic complications can occur during or after these interventions.
- Understanding complication types and effective treatments is crucial for patient outcomes.
Purpose of the Study:
- To describe clinical experiences and outcomes of thromboembolic complications during endovascular treatment of intracranial aneurysms.
- To classify complication types and evaluate treatment modalities.
- To review existing literature on managing these complications.
Main Methods:
- Retrospective evaluation of 173 patients (189 aneurysms) treated between 2004-2009.
- Classification of thromboembolic complications into mechanical obstruction, distal embolic stroke, and stent-induced categories.
- Comparison of clinical results based on complication type and treatment.
Main Results:
- A low incidence of thromboembolic complications (4.6%, 8/173 patients) was observed.
- Mechanical obstruction and stent-induced complications had poor prognoses despite thrombolytics.
- Distal embolic stroke cases showed good outcomes with antiplatelet agents.
Conclusions:
- Treatment for mechanical obstruction and stent-induced complications with antiplatelet and thrombolytic agents has limited effectiveness.
- Active interventions such as balloon angioplasty, stent insertion, and clot extraction are recommended.
- Further research into optimal management strategies for these rare but serious complications is warranted.
Objective:
We describe our clinical experiences and outcomes in patients who had thromboembolic complications occurring during endovascular treatment of intracerebral aneurysms with a review of the literature. The types of thromboembolic complications were divided and the treatment modalities for each type were described.
Methods:
Between August 2004 and March 2009 we performed endovascular embolization with Guglielmi detachable coils for 173 patients with 189 cerebral aneurysms, including ruptured and unruptured aneurysms at our hospital. Sixty-eight patients were males and 105 patients were females. The age of patients ranged from 22-82 years (average, 58.8 years). We retrospectively evaluated this group with regard to complication rates and outcomes. The types of thromboembolic complications were classified into the following three categories: mechanical obstruction, distal embolic stroke, and stent-induced complications, which corresponded to types I, II, and III, respectively. A comparison of the clinical results was made for each type of complication.
Results:
Only eight patients had a thromboembolic complication during or after a procedure (4.6%). Of the eight patients, two had a mechanical obstruction as the causative factor; the other three patients had distal embolic stroke as the causative factor. The remaining three patients had stent-induced complications. In cases of mechanical obstruction, recanalization occurred due to the use of intra-arterial thrombolytic agents in one of two patients. Nevertheless, a poor prognosis was seen. In the cases of stent-induced complications, in one of three patients in whom a thrombus developed following stent insertion, a middle cerebral artery territory infarct developed with a poor prognosis despite the use of wiring and an intra-arterial thrombolytic agent. In the cases of distal embolic stroke, all three patients achieved good results following the use of antiplatelet agents.
Conclusion:
Treatment for thromboemboic complications due to mechanical obstruction and stent-induced complications include antiplatelet and intra-arterial thrombolytic agents; however, this cannot guarantee a sufficient extent of effectiveness. Therefore, active treatments, such as balloon angioplasty, stent insertion, and clot extraction, are helpful.
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