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Prophylactic thrombosis to prevent new bleeding and to delay aneurysm surgery
K Kinugasa1, S Mandai, I Kamata
1Department of Neurological Surgery, Okayama University Medical School, Japan.
Neurosurgery
|April 1, 1995
Summary
Direct thrombosis of acute aneurysms using cellulose acetate polymer, followed by aggressive volume expansion or intrathecal tissue plasminogen activator, shows promise in preventing re-bleeding and reducing delayed cerebral ischemia after subarachnoid hemorrhage.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Neuroradiology
Background:
- Acute aneurysmal subarachnoid hemorrhage presents a high risk of re-bleeding and delayed cerebral ischemia.
- Current treatment strategies aim to secure the aneurysm and manage complications.
Observation:
- Six aneurysms in five patients with acute aneurysmal subarachnoid hemorrhage were treated with direct thrombosis using cellulose acetate polymer within 4 hours of rupture.
- Aneurysms involved various intracranial arteries including internal carotid, posterior communicating, anterior choroidal, basilar, and middle cerebral arteries.
- Four patients received aggressive volume expansion post-thrombosis, and three received intrathecal tissue plasminogen activator.
Findings:
- Aneurysms remained thrombosed until surgical intervention 2-7 weeks post-hemorrhage.
- Five aneurysms were successfully clipped in four patients.
- One patient with neurological Grade V did not undergo surgical treatment and died from cardiac failure.
Implications:
- Immediate aneurysmal thrombosis with cellulose acetate polymer may be a viable adjunct therapy.
- Aggressive preoperative volume expansion and/or intrathecal tissue plasminogen activator may mitigate risks of re-bleeding and delayed cerebral ischemia.
- These preliminary findings warrant further investigation in larger clinical trials for subarachnoid hemorrhage management.