Patterns, Predictors, and Outcomes of Post Procedure Delayed Hemorrhage Following Flow Diversion for Intracranial Aneurysm Treatment.

Patterns, Predictors, and Outcomes of Post Procedure Delayed Hemorrhage Following Flow Diversion for Intracranial Aneurysm Treatment.

World Neurosurg. 2018 Apr 04;:

Authors: White AC, Kumpe DA, Roark CD, Case DE, Seinfeld J

Abstract
PURPOSE: To evaluate patterns, predictors, and outcomes of post procedure delayed hemorrhage (PPDH) following flow diversion therapy for intracranial aneurysm.
METHODS: 50 patients with 52 aneurysms were treated from 2012-2016 with the Pipeline Embolization Device (PED; Medtronic, Minneapolis, MN). PED placement was performed as a standalone therapy or with adjunctive coil embolization. Patients underwent dual antiplatelet therapy (DAT) for 6 months following treatment. Medical comorbidities, aneurysm traits, and treatment factors, including platelet function testing, were studied. Statistical analysis was performed utilizing cross-tabulation.
RESULTS: Six PPDHs (12%) occurred between 2 and 16 days (mean 6.8) following PED placement and presented as one of two distinct patterns: convexity subarachnoid hemorrhage (cSAH; n=4) or lobar intraparenchymal hemorrhage (IPH; n=2). All PPDHs occurred ipsilateral to the device, while 1of the IPHs occurred ipsilateral but in a different arterial territory. Both treated anterior communicating artery (ACoA) aneurysms experienced PPDH. Cases of PPDH demonstrated on average lower P2Y12 reactivity unit (PRU) values at the time of treatment. Platelet function testing at the time of hemorrhage was consistently hypertherapeutic. Patients with cSAH had only minimal worsening of modified Rankin Scale at the time of discharge, while the 2 patients with IPH experienced significant deterioration.
CONCLUSION: PPDH is a poorly understood complication following flow diversion therapy that can result in significant morbidity. In our experience, non-aneurysmal minor SAH does not result in poor clinical outcomes, while IPH leads to long-term deficits or death. As previously suggested, there appears to be a trend between low PRU value and PPDH.

PMID: 29626682 [PubMed - as supplied by publisher]

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