Detection of microemboli distal to cerebral aneurysms before and after therapeutic embolization

Recently developed interventional radiologic techniques, such as embolization with platinum coils, may induce thrombus formation within an aneurysm. The aim of the present study was to investigate the frequency of microemboli distal to untreated and treated cerebral aneurysms.

Among a total of 110 patients treated with platinum coil embolization, 35 patients (27 women and eight men, aged 50+/-10 years) who were at high risk of ischemic complications underwent emboli detection with a transcranial Doppler sonographic monitoring system. All patients were studied before and after coil embolization. The aneurysms were located at the internal carotid artery (n=14), the basilar artery (n=10), the middle cerebral artery (n=7), or the vertebral artery (n=4). Twenty-nine (85%) of 35 patients were monitored within 6 hours of the completion of treatment.

Microemboli distal to the aneurysm were not detected in any of the patients before treatment. Microemboli were detected in 11 patients (31%) after embolization (mean, 16+/-21 per hour; range, 1-74 per hour). Microemboli were detected in five (71%) of seven patients in whom ischemic complications occurred after treatment, but in only six (21%) of 28 asymptomatic patients. This difference was statistically significant. The rate of occurrence of emboli in patients with ischemic complications (23+/-30 emboli per hour) was higher than in asymptomatic patients (10+/-7 emboli per hour), but this difference was not statistically significant.

Microemboli were detected significantly more often in patients who suffered from cerebral ischemia after coil embolization of an intracranial aneurysm. This observation supports the definition of a high-risk group of patients with incomplete embolization or with a large-diameter, broad-neck aneurysm. The early detection of microemboli after treatment may be an indicator for excessive intraaneurysmal thrombus formation and could influence the decision for prophylactic treatment with heparin or aspirin.