Antiplatelet Premedication-Free Stent-Assisted Coil Embolization in Acutely Ruptured Aneurysms.

Antiplatelet Premedication-Free Stent-Assisted Coil Embolization in Acutely Ruptured Aneurysms.

World Neurosurg. 2018 Mar 31;:

Authors: Choi HH, Cho YD, Han MH, Cho WS, Kim JE, Lee JJ, An SJ, Mun JH, Yoo DH, Kang HS

Abstract
INTRODUCTION: Stent-assisted coil embolization (SAC) is one of the treatment options for patients with intracranial aneurysms. The purpose of this study was to assess clinical outcomes of patients who underwent coil embolization for acutely ruptured aneurysms without antiplatelet premedication.
METHODS: A total of 449 patients with acutely ruptured aneurysms underwent endovascular treatment without antiplatelet premedication between April 2006 and October 2015. Among them, 55 patients underwent SAC (SAC group) and 394 underwent coiling without stent assistance (non-SAC group). Periprocedural complications and clinical outcomes at postictal six months were compared between the two groups.
RESULTS: The rate of hemorrhagic complications showed no significant difference (SAC group vs. non-SAC group, 9.1% vs. 4.8%). Although procedural thromboembolism occurred more frequently in the SAC group (25.5% vs. 12.4%; p = 0.01), poor clinical outcomes (modified Rankin scale score ≥ 3) were comparable (30.9% vs. 22.1%). In the multivariate analysis, Hunt-Hess grade (OR = 4.22; p < 0.001), hemorrhagic complications (OR = 4.01; p = 0.018), and age (OR = 1.04, p = 0.001) were independent predictors of poor clinical outcomes, but stent-assisted coil embolization and procedural thromboembolism were not.
CONCLUSION: Although procedure-related thromboembolism occurred more frequently, comparable treatment outcomes could be achieved with antiplatelet premedication-free SAC in patients with acutely ruptured aneurysms. The use of stents and thromboembolic complications were not significant risk factors for poor clinical outcome.

PMID: 29614363 [PubMed - as supplied by publisher]

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