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Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases
M L Hahnemann1, A Ringelstein1, I E Sandalcioglu2
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany.
Purpose:
New ischemic brain lesions are common findings after cerebral diagnostic angiography and endovascular therapy. Diffusion-weighted MRI (DWI) can be used for detection of these lesions. The aim of the present study was to investigate the incidence of DWI lesions after stent-assisted coiling and the evaluation of possible risk factors.
Methods:
The study included a total of 75 consecutive patients treated with stent-assisted coiling. Post-procedural DWI of the brain was performed to detect ischemic lesions. Demographic data, aneurysm characteristics and angiographic parameters were correlated with properties of DWI lesions.
Results:
In post-procedural DWI, 48 of the 75 patients (64%) had 163 DWI lesions in a pattern consistent with embolic events. The number of patients with DWI lesions was significantly increased in older patients (≥55 years) and longer intervention times (≥120 min). The ischemic brain volume was significantly increased in older patients (≥55 years) as well as in patients who were implanted with a shorter stent (<20 mm).
Conclusions:
Thromboembolic events are common after stent-assisted coiling with an incidence comparable to DWI studies after coiling alone. Despite several devices and low operator experience, stent-assisted coiling for intracranial aneurysms has a very low risk of permanent neurologic disability. Further studies are necessary to improve the safety of stent-assisted coiling for patients in conditions with increased risk potential (age, procedure time, stent length).
Insights
New ischemic brain lesions are common after stent-assisted coiling, with 64% of patients showing lesions on diffusion-weighted MRI (DWI). Older age and longer procedure times increase lesion incidence, highlighting areas for improved safety.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Neuroimaging
Background:
- New ischemic brain lesions frequently occur after cerebral diagnostic angiography and endovascular therapy.
- Diffusion-weighted MRI (DWI) is a key imaging technique for detecting these post-procedural lesions.
Purpose of the Study:
- To determine the incidence of DWI lesions following stent-assisted coiling.
- To identify potential risk factors associated with these lesions.
Main Methods:
- A cohort of 75 consecutive patients undergoing stent-assisted coiling was analyzed.
- Post-procedural brain DWI was performed to detect and characterize ischemic lesions.
- Demographic, aneurysm, and angiographic data were correlated with DWI findings.
Main Results:
- 64% of patients (48/75) exhibited 163 DWI lesions, indicative of embolic events.
- Increased DWI lesion incidence was observed in older patients (≥55 years) and those with longer intervention times (≥120 min).
- Greater ischemic brain volume was associated with older age and shorter stent length (<20 mm).
Conclusions:
- Thromboembolic events are frequent after stent-assisted coiling, with an incidence similar to coiling alone.
- Stent-assisted coiling demonstrates a low risk of permanent neurologic disability despite device variations and operator experience.
- Further research is needed to enhance safety for high-risk patients, considering age, procedure duration, and stent length.
