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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Flow diversion of ruptured intracranial aneurysms: a single-center study with a standardized antithrombotic treatment
Anni Rantamo1, Camille Gallé2,3, Jussi Numminen2
1Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland. anni.rantamo@helsinki.fi.
Insights
Implementing a standardized antithrombotic protocol after flow diversion for ruptured intracranial aneurysms did not significantly alter complication rates. Further research is needed for evidence-based guidelines on antithrombotic therapy post-flow diversion for ruptured intracranial aneurysms.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Flow diversion is a treatment for ruptured intracranial aneurysms (IA).
- Antithrombotic medication use after flow diversion for ruptured IA lacks guidelines.
- This study evaluates complications and outcomes before and after a standardized antithrombotic protocol.
Purpose of the Study:
- To investigate the incidence of treatment-related complications after flow diversion for ruptured IA.
- To assess patient outcomes following flow diversion for ruptured IA.
- To compare outcomes before and after implementing a standardized antithrombotic medication protocol.
Main Methods:
- Single-center retrospective study (2015-2023) of patients with acutely ruptured IA treated with flow diversion.
- Patients divided into pre-protocol and post-protocol groups.
- Primary outcomes: hemorrhagic and ischemic complications. Secondary outcome: modified Rankin Scale (mRS).
Main Results:
- 39 patients (40 ruptured IAs) treated; 69% pre-protocol, 31% post-protocol.
- Increased use of glycoprotein IIb/IIIa inhibitors and dual antiplatelets in the post-protocol group.
- No significant differences in ischemic (37% vs. 42%) or hemorrhagic (30% vs. 33%) complications. Three re-ruptures in pre-group, none in post-group. No differences in mortality or mRS 0-2 at 6 months.
Conclusions:
- A standardized antithrombotic protocol did not significantly change complication rates for acute flow diversion in ruptured IA.
- There is a critical need for evidence-based guidelines to optimize antithrombotic treatment post-flow diversion for subarachnoid hemorrhage.
- Further research is warranted to establish optimal antithrombotic strategies.
Background:
The use of antithrombotic medication following acute flow diversion for a ruptured intracranial aneurysm (IA) is challenging with no current guidelines. We investigated the incidence of treatment-related complications and patient outcomes after flow diversion for a ruptured IA before and after the implementation of a standardized antithrombotic medication protocol.
Methods:
We conducted a single-center retrospective study including consecutive patients treated for acutely ruptured IAs with flow diversion during 2015-2023. We divided the patients into two groups: those treated before the implementation of the protocol (pre-protocol) and those treated after the implementation of the protocol (post-protocol). The primary outcomes were hemorrhagic and ischemic complications. A secondary outcome was clinical outcome using the modified Ranking Scale (mRS).
Results:
Totally 39 patients with 40 ruptured IAs were treated with flow diversion (69% pre-protocol, 31% post-protocol). The patient mean age was 55 years, 62% were female, 63% of aneurysms were in the posterior circulation, 92% of aneurysms were non-saccular, and 44% were in poor grade on admission. Treatment differences included the use of glycoprotein IIb/IIIa inhibitors (pre-group 48% vs. post-group 100%), and the use of early dual antiplatelets (pre-group 44% vs. 92% post-group). The incidence of ischemic complications was 37% and 42% and the incidence of hemorrhagic complications was 30% and 33% in the pre- and post-groups, respectively, with no between-group differences. There were three (11%) aneurysm re-ruptures in the pre-group and none in the post-group. There were no differences in mortality or mRS 0-2 between the groups at 6 months.
Conclusion:
We found no major differences in the incidence of ischemic or hemorrhagic complications after the implementation of a standardized antithrombotic protocol for acute flow diversion for ruptured IAs. There is an urgent need for more evidence-based guidelines to optimize antithrombotic treatment after flow diversion in the setting of subarachnoid hemorrhage.
