Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

Authors

  • Marinova R. Department of Anesthesiology and Intensive Care, Military Medical Academy-Sofia, Sofia, Bulgaria
  • Petrov N. Department of Anesthesiology and Intensive Care, Military Medical Academy-Sofia, Sofia, Bulgaria
  • Odiseeva Ev. Department of Anesthesiology and Intensive Care, Military Medical Academy-Sofia, Sofia, Bulgaria

DOI:

https://doi.org/10.31907/2310-9394.2020.08.02

Keywords:

Intracranial Aneurysm, Endovascular Coiling, Subarachnoid Hemorrhage.

Abstract

Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

References

Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366: 809–817. https://doi.org/10.1016/s0140-6736(05)67214-5

Brisman JL, Niimi Y, Song JK, et al. Aneurysmal rupture during coiling: Low incidence and good outcomes at a single large volume center. Neurosurgery 2005; 57: 1103–1109. discussion 1103– 1109. https://doi.org/10.1227/01.neu.0000185631.20246.1a

Pierot L, Spelle L, Vitry F, et al. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: Results of the ATENA study. Stroke 2008; 39: 2497–2504. https://doi.org/10.1161/strokeaha.107.512756

Elijovich L, Higashida RT, Lawton MT, et al. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: The CARAT study. Stroke 2008; 39: 1501–1506. https://doi.org/10.1161/strokeaha.107.504670

Cloft HJ, Kallmes DF. Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: A meta-analysis. AJNR Am J Neuroradiol 2002; 23: 1706–1709. https://doi.org/10.1177/159101990601200106

Schuette AJ, Hui FK, Spiotta AM, et al. Endovascular therapy of very small aneurysms of the anterior communicating artery: Five-fold increased incidence of rupture. Neurosurgery 2011; 68: 731–737. discussion: 737. https://doi.org/10.1227/neu.0b013e3182077373

Kawabata S, Imamura H, Adachi H, et al. Risk factors for and outcomes of intraprocedural rupture during endovascular treatment of unruptured intracranial aneurysms. J Neurointerv Surg. Epub ahead of print July 2017. https://doi.org/10.1136/neurintsurg-2017-013156

Santillan A, Gobin YP, Greenberg ED, et al. Intraprocedural aneurysmal rupture during coil embolization of brain aneurysms: Role of balloonassisted coiling. AJNR Am J Neuroradiol 2012; 33: 2017–2021. https://doi.org/10.3174/ajnr.a3061

Oishi H, Yamamoto M, Shimizu T, et al. Endovascular therapy of 500 small asymptomatic unruptured intracranial aneurysms. AJNR Am J Neuroradiol 2012; 33: 958–964. https://doi.org/10.3174/ajnr.a2858

Gonzalez N, Sedrak M, Martin N, et al. Impact of anatomic features in the endovascular embolization of 181 anterior communicating artery aneurysms. Stroke 2008; 39: 2776–2782. https://doi.org/10.1161/strokeaha.107.505222

Santillan A, Gobin YP, Mazura JC, et al. Balloonassisted coil embolization of intracranial aneurysms is not associated with increased periprocedural complications. J Neurointerv Surg 2013; 5: iii56–iii61. https://doi.org/10.1136/neurintsurg-2012-010351

Lubicz B, Lefranc F, Bruneau M, et al. Balloonassisted coiling of intracranial aneurysms is not associated with a higher complication rate. Neuroradiology 2008; 50: 769–776. https://doi.org/10.1007/s00234-008-0397-3

Shapiro M, Babb J, Becske T, et al. Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: A literature review. AJNR Am J Neuroradiol 2008; 29: 1777–1781. https://doi.org/10.3174/ajnr.a1216

van Rooij WJ, Sluzewski M, Beute GN, et al. Procedural complications of coiling of ruptured intracranial aneurysms: Incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 2006; 27: 1498–1501.

Park SD, Kim JH, Chang CH, et al. Procedurerelated complication rate for the endovascular treatment of aneurysmal subarachnoid hemorrhage under local anesthesia. J Cerebrovasc Endovasc Neurosurg 2016; 18: 215–222. https://doi.org/10.7461/jcen.2016.18.3.215

Chen M. A checklist for cerebral aneurysm embolization complications. J Neurointerv Surg 2013; 5: 20–27. https://doi.org/10.1136/neurintsurg-2011-010137

Jabori S, Jimenez JC, Gabriel V, et al. Is heparin reversal required for the safe performance of percutaneous endovascular aortic aneurysm repair? Ann Vasc Surg 2013; 27: 1049–1053. https://doi.org/10.1016/j.avsg.2013.04.008

Willinsky R, terBrugge K. Use of a second microcatheter in the management of a perforation during endovascular treatment of a cerebral aneurysm. AJNR Am J Neuroradiol 2000; 21: 1537– 1539.

Patsalides A, Smith M, Gobin YP. Intra-procedural aneurysm rupture treated with n-butyl cyanoacrylate embolization: Technical note. J Neurointerv Surg 2010; 2: 145–146. https://doi.org/10.1136/jnis.2009.001180

McDougall CG, Halbach VV, Dowd CF, et al. Causes and management of aneurysmal hemorrhage occurring during embolization with Guglielmi detachable coils. J Neurosurg 1998; 89: 87– 92. https://doi.org/10.3171/jns.1998.89.1.0087

Lim YC, Kim BM, Shin YS, et al. Structural limitations of currently available microcatheters and coils for endovascular coiling of very small aneurysms. Neuroradiology 2008; 50: 423–427. https://doi.org/10.1007/s00234-008-0365-y

Park HK, Horowitz M, Jungreis C, et al. Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2005; 26: 506– 514.

Im SH, Han MH, Kwon OK, et al. Endovascular coil embolization of 435 small asymptomatic unruptured intracranial aneurysms: Procedural morbidity and patient outcome. AJNR Am J Neuroradiol 2009; 30: 79–84. https://doi.org/10.3174/ajnr.a1290

Altay T, Kang HI, Woo HH, et al. Thromboembolic events associated with endovascular treatment of cerebral aneurysms. J Neurointerv Surg 2011; 3: 147– 150. https://doi.org/10.1136/jnis.2010.003616

Ries T, Siemonsen S, Grzyska U, et al. Abciximab is a safe rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization: Single center experience in 42 cases and review of the literature. Stroke 2009; 40: 1750–1757. https://doi.org/10.1161/strokeaha.108.539197

Derdeyn CP, Cross DT, 3rd, Moran CJ, et al. Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 2002; 96: 837–843. https://doi.org/10.3171/jns.2002.96.5.0837

Kim DY, Park JC, Kim JK, et al. Microembolism after endovascular treatment of unruptured cerebral aneurysms: Reduction of its incidence by microcatheter lumen aspiration. Neurointervention 2015; 10: 67–73. https://doi.org/10.5469/neuroint.2015.10.2.67

Hu YC, Deshmukh VR, Albuquerque FC, et al. Histopathological assessment of fatal ipsilateral intraparenchymal hemorrhages after the treatment of supraclinoid aneurysms with the pipeline embolization device. J Neurosurg 2014; 120: 365–374. https://doi.org/10.3171/2013.11.jns131599

Piotin M, Blanc R, Spelle L, et al. Stent-assisted coiling of intracranial aneurysms: Clinical and angiographic results in 216 consecutive aneurysms. Stroke 2010; 41: 110–115. https://doi.org/10.1161/strokeaha.109.558114

Bodily KD, Cloft HJ, Lanzino G, et al. Stent-assisted coiling in acutely ruptured intracranial aneurysms: A qualitative, systematic review of the literature. AJNR Am J Neuroradiol 2011; 32: 1232–1236. https://doi.org/10.3174/ajnr.a2478

Yang H, Sun Y, Jiang Y, et al. Comparison of stentassisted coiling vs coiling alone in 563 intracranial aneurysms: Safety and efficacy at a high-volume center. Neurosurgery 2015; 77: 241–247. discussion: 247. https://doi.org/10.1227/neu.0000000000000765

Fujii Y, Takeuchi S, Sasaki O, et al. Serial changes of hemostasis in aneurysmal subarachnoid hemorrhage with special reference to delayed ischemic neurological deficits. J Neurosurg 1997; 86: 594–602. https://doi.org/10.3171/jns.1997.86.4.0594

Gupta V, Tanvir R, Garg A, et al. Heparin-induced thrombocytopenia in a case of endovascular aneurysm coiling. AJNR Am J Neuroradiol 2007; 28: 155–158.

Pierot L, Condette-Auliac S, Piette AM, et al. Thromboembolic events after endovascular treatment of unruptured intracranial aneurysms in two patients with antiphospholipid-antibody syndrome. Neuroradiology 2002; 44: 355–357. https://doi.org/10.1007/s00234-001-0727-1

Cronqvist M, Pierot L, Boulin A, et al. Local intraarterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracerebral aneurysm: A comparison of anatomic results and clinical outcome. AJNR Am J Neuroradiol 1998; 19: 157–165.

Song JK, Niimi Y, Fernandez PM, et al. Thrombus formation during intracranial aneurysm coil placement: Treatment with intra-arterial abciximab. AJNR Am J Neuroradiol 2004; 25: 1147–1153.

Brinjikji W, McDonald JS, Kallmes DF, et al. Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms. Stroke 2013; 44: 1343–1347. https://doi.org/10.1161/strokeaha.111.000628

Ng PP, Phatouros CC, Khangure MS. Use of glycoprotein IIb-IIIa inhibitor for a thromboembolic complication during Guglielmi detachable coil treatment of an acutely ruptured aneurysm. AJNR Am J Neuroradiol 2001; 22: 1761–1763.

Linfante I, Etezadi V, Andreone V, et al. Intraarterial abciximab for the treatment of thrombus formation during coil embolization of intracranial aneurysms. J Neurointerv Surg 2010; 2: 135–138. https://doi.org/10.1136/jnis.2009.001933

Martinez-Perez R, Lownie SP, Pelz D. Intra-arterial use of abciximab in thromboembolic complications associated with cerebral aneurysm coiling: The London Ontario experience. World Neurosurg 2017; 100: 342– 350. https://doi.org/10.1016/j.wneu.2017.01.023

Park JH, Kim JE, Sheen SH, et al. Intraarterial abciximab for treatment of thromboembolism during coil embolization of intracranial aneurysms: Outcome and fatal hemorrhagic complications. J Neurosurg 2008; 108: 450–457. https://doi.org/10.3171/jns/2008/108/3/0450

Cho YD, Lee JY, Seo JH, et al. Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms. Eur J Radiol 2012; 81: 2833–2838. https://doi.org/10.1016/j.ejrad.2011.11.023

Jeong HW, Jin SC. Intra-arterial infusion of a glycoprotein IIb/IIIa antagonist for the treatment of thromboembolism during coil embolization of intracranial aneurysm: A comparison of abciximab and tirofiban. AJNR Am J Neuroradiol 2013; 34: 1621– 1625. https://doi.org/10.3174/ajnr.a3501

Kang DH, Kim YS, Park J, et al. Rescue forcedsuction thrombectomy using the reperfusion catheter of the Penumbra System for thromboembolism during coil embolization of ruptured cerebral aneurysms. Neurosurgery 2012; 70: 89–93. discussion 93–84. https://doi.org/10.1227/neu.0b013e31822fefc4

Ahn JH, Jun HS, Song JH, et al. Rescue mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms. J Neurointerv Surg 2017; 9: 244–249. https://doi.org/10.1136/neurintsurg-2016-012457

Chalouhi N, Dumont AS, Hasan D, et al. Is packing density important in stent-assisted coiling? Neurosurgery 2012; 71: 381–386. discussion: 386–387. https://doi.org/10.1227/neu.0b013e31825c36dd

Colby GP, Paul AR, Radvany MG, et al. A single center comparison of coiling versus stent assisted coiling in 90 consecutive paraophthalmic region aneurysms. J Neurointerv Surg 2012; 4: 116–120. https://doi.org/10.1136/jnis.2011.004911

Hwang G, Jung C, Park SQ, et al. Thromboembolic complications of elective coil embolization of unruptured aneurysms: The effect of oral antiplatelet preparation on periprocedural thromboembolic complication. Neurosurgery 2010; 67: 743–748. discussion: 748. https://doi.org/10.1227/01.neu.0000374770.09140.fb

Kim B, Kim K, Jeon P, et al. Thromboembolic complications in patients with clopidogrel resistance after coil embolization for unruptured intracranial aneurysms. AJNR Am J Neuroradiol 2014; 35: 1786– 1792. https://doi.org/10.3174/ajnr.a3955

Edwards NJ, Jones WH, Sanzgiri A, et al. Antiplatelet therapy for the prevention of peri-coiling thromboembolism in high-risk patients with ruptured intracranial aneurysms. J Neurosurg 2017, pp. 1–7. https://doi.org/10.3171/2016.9.jns161340

Lee DH, Arat A, Morsi H, et al. Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: A singlecenter experience. AJNR Am J Neuroradiol 2008; 29: 1389–1394. https://doi.org/10.3174/ajnr.a1070

Hussein HM, Emiru T, Georgiadis AL, et al. Assessment of platelet inhibition by point-of-care testing in neuroendovascular procedures. AJNR Am J Neuroradiol 2013; 34: 700–706. https://doi.org/10.3174/ajnr.a2963

Fifi JT, Brockington C, Narang J, et al. Clopidogrel resistance is associated with thromboembolic complications in patients undergoing neurovascular stenting. AJNR Am J Neuroradiol 2013; 34: 716–720. https://doi.org/10.3174/ajnr.a3405

Hwang G, Huh W, Lee JS, et al. Standard vs modified antiplatelet preparation for preventing thromboembolic events in patients with high ontreatment platelet reactivity undergoing coil embolization for an unruptured intracranial aneurysm: A randomized clinical trial. JAMA Neurol 2015; 72: 764–772. https://doi.org/10.1001/jamaneurol.2015.0654

Delgado Almandoz JE, Kadkhodayan Y, Crandall BM, et al. Variability in initial response to standard clopidogrel therapy, delayed conversion to clopidogrel hyper-response, and associated thromboembolic and hemorrhagic complications in patients undergoing endovascular treatment of unruptured cerebral aneurysms. J Neurointerv Surg 2014; 6: 767–773. https://doi.org/10.1136/neurintsurg-2013-010976

Oran I, Cinar C, Bozkaya H, et al. Tailoring platelet inhibition according to multiple electrode aggregometry decreases the rate of thrombotic complications after intracranial flow-diverting stent implantation. J Neurointerv Surg 2015; 7: 357–362. https://doi.org/10.1136/neurintsurg-2013-011023

Chalouhi N, Jabbour P, Daou B, et al. A new protocol for anticoagulation with tirofiban during flow diversion. Neurosurgery 2016; 78: 670–674. https://doi.org/10.1227/neu.0000000000001071

Rouchaud A, Brinjikji W, Lanzino G, et al. Delayed hemorrhagic complications after flow diversion for intracranial aneurysms: A literature overview. Neuroradiology 2016; 58: 171–177. https://doi.org/10.1007/s00234-015-1615-4

Hampton T, Walsh D, Tolias C, et al. Mural destabilization after aneurysm treatment with a flowdiverting device: A report of two cases. J Neurointerv Surg 2011; 3: 167–171. https://doi.org/10.1136/jnis.2010.002873

Fox B, Humphries WE, Doss VT, et al. Rupture of giant vertebrobasilar aneurysm following flow diversion: Mechanical stretch as a potential mechanism for early aneurysm rupture. J Neurointerv Surg 2015; 7: e37. https://doi.org/10.1136/neurintsurg-2014-011325.rep

Patel A, Miller TR, Shivashankar R, et al. Early angiographic signs of acute thrombus formation following cerebral aneurysm treatment with the Pipeline embolization device. J Neurointerv Surg 2017; 9: 1125–1130. https://doi.org/10.1136/neurintsurg-2016-012701

Kallmes DF, Hanel R, Lopes D, et al. International retrospective study of the pipeline embolization device: A multicenter aneurysm treatment study. AJNR Am J Neuroradiol 2015; 36: 108–115.

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2020-10-09

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