Specifics of endovascular embolization for cerebral aneurysmsin the acute period of subarachnoid hemorrhage
DOI:
https://doi.org/10.14739/2310-1210.2021.6.235069Keywords:
endovascular embolization, complications, subarachnoid hemorrhageAbstract
Aim – to assess the benefits of modern methods for endovascular occlusion of ruptured cerebral aneurysms in the acute period of subarachnoid hemorrhage (SAН).
Materials and methods. Medical records of patients undergoing treatment in the acute period of aneurysmal SAН between 2010–2021 were analyzed. 2 groups were formed: I – the use of standard surgical catheters, minimal use of adjunctive techniques for aneurysm embolization (2010–2016), II – routine use of triaxial access systems, intraarterial infusion of nimodipine, active use of adjunctive techniques for aneurysm embolization, intraoperative antiplatelet therapy immediately after aneurysm occlusion – 500 mg of solution Acelysin administrated intravenously (2017–2021). The severity of SAН according to the Hunt–Hess, Fisher scales, the treatment outcome according to the modified Rankin Scale (mSR), the location and size of aneurysms and intraoperative complications were analyzed.
Results. There were 156 observations in group I, 91 – in group II. The median age was 48.26 years in group I, 51.44 years – in group II. On the basis of gender status, there was a majority of women in both groups. Aneurysms of the anterior cerebral-anterior communicating artery complex predominated in both groups; the internal carotid artery was the second most frequent localization. The severity of SAН according to the generally accepted scales (Hunt–Hess, Fisher) did not differ significantly.
Coil embolization was used in 100 % of cases, balloon-assisted coiling was used in 6.48 % in group I and in 14.80 % – in group II, stent-assisted coiling – in 2.56 % and 9.30 %, respectively, distal access catheter with the triaxial system was not used in group I and it was performed in 57.4 % of cases in group II. Pharmacoangioplasty using nimodipine solution was used in 16.6 % in group I and in 22.2 % in group II. Intravenous drip infusion of 0.5 g Acelysin was performed immediately after aneurysm occlusion in 22.2 % of cases in group II. Intraoperative aneurysm rupture was observed in 5.1 % in group I and in 1.1 % in group II. Distal coil migration or into the maternal artery occurred in 6.41 % in group I and in 2.20 % in group II. Thromboembolic complications were noted in 7.69 % and in 2.20 %, respectively. The mean value of dysfunction degree on mSR amounted to 2.27 in group I and 1.45 – in group II. A good treatment outcome (mRS score 1–2) was defined in 71.2 % of observations in group I and in 87.9 % – in group II. The death rate was 12.82 % and 7.62 %, respectively.
Conclusions. Routine use of triaxial access systems and intraarterial pharmacoplasty with nimodipine allow adequate prevention of mechanically induced vasospasm during catheterization of the aneurysm cavity. The triaxial access system stability provides better control of the microguidewire and microcatheters reducing the risk of aneurysmal wall perforation during catheterization. The use of adjunctive techniques for embolization of ruptured cerebral aneurysms in the acute period of SAH and prophylactic infusion of Acelysin solution after aneurysm occlusion significantly reduces the incidence of thromboembolic complications. The earliest possible occlusion of a ruptured cerebral aneurysm is not only the prevention of re-rupture, but also expands the possibilities of intensive care for preventing secondary complications of SAH.
References
de Rooij, N. K., Linn, F. H., van der Plas, J. A., Algra, A., & Rinkel, G. J. (2007). Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. Journal of Neurology, Neurosurgery & Psychiatry, 78(12), 1365-1372. https://doi.org/10.1136/jnnp.2007.117655
Starke, R. M., Connolly, E. S., Jr., & Participants in the International Multi-Disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage. (2011). Rebleeding After Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care, 15(2), Article 241. https://doi.org/10.1007/s12028-011-9581-0
Huang, J., & van Gelder, J. M. (2002). The Probability of Sudden Death from Rupture of Intracranial Aneurysms: A Meta-analysis. Neurosurgery, 51(5), 1101-1107. https://doi.org/10.1097/00006123-200211000-00001
Steiner, T., Juvela, S., Unterberg, A., Jung, C., Forsting, M., Rinkel, G., & European Stroke Organization. (2013). European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovascular Diseases, 35(2), 93-112. https://doi.org/10.1159/000346087
Connolly, E. S., Jr., Rabinstein, A. A., Carhuapoma, J. R., Derdeyn, C. P., Dion, J., Higashida, R. T., Hoh, B. L., Kirkness, C. J., Naidech, A. M., Ogilvy, C. S., Patel, A. B., Thompson, B. G., Vespa, P., American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, & Council on Clinical Cardiology. (2012). Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 43(6), 1711-1737. https://doi.org/10.1161/STR.0b013e3182587839
Ihn, Y. K., Shin, S. H., Baik, S. K., & Choi, I. S. (2018). Complications of endovascular treatment for intracranial aneurysms: Management and prevention. Interventional Neuroradiology, 24(3), 237-245. https://doi.org/10.1177/1591019918758493
Netlyukh, А. М. (2017). Khirurhichne likuvannia khvorykh z rozryvamy vnutrishnocherepnykh arterialnykh anevryzm z uskladnenym klinichnym perebihom. Dis. … dok. med. nauk. [Surgical treatment of cerebral aneurysms’ rupture with a complicated disease course Dr. med. sci. diss.]. Lvivskyi nats. med. un-t im. D. Halytskoho MOZ Ukrainy. [in Ukrainian].
Lylyk, P., Cohen, J. E., Ceratto, R., Ferrario, A., & Miranda, C. (2002). Angioplasty and Stent Placement in Intracranial Atherosclerotic Stenoses and Dissections. American Journal of Neuroradiology, 23(3), 430-436.
Pierot, L., Barbe, C., Nguyen, H. A., Herbreteau, D., Gauvrit, J. Y., Januel, A. C., Bala, F., Comby, P. O., Desal, H., Velasco, S., Aggour, M., Chabert, E., Sedat, J., Trystram, D., Marnat, G., Gallas, S., Rodesch, G., Clarençon, F., Soize, S., Gawlitza, M., … White, P. (2020). Intraoperative Complications of Endovascular Treatment of Intracranial Aneurysms with Coiling or Balloon-assisted Coiling in a Prospective Multicenter Cohort of 1088 Participants: Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study. Radiology, 295(2), 381-389. https://doi.org/10.1148/radiol.2020191842
Wang, J. M., & Chen, Q. X. (2020). Risk Factors for Intraprocedural Rerupture during Embolization of Ruptured Intracranial Aneurysms. Journal of Korean Medical Science, 35(48), Article e430. https://doi.org/10.3346/jkms.2020.35.e43030
Stapleton, C. J., Walcott, B. P., Butler, W. E., & Ogilvy, C. S. (2015). Neurological outcomes following intraprocedural rerupture during coil embolization of ruptured intracranial aneurysms. Journal of Neurosurgery, 122(1), 128-135. https://doi.org/10.3171/2014.9.JNS14616
Johnston, S. C., Dowd, C. F., Higashida, R. T., Lawton, M. T., Duckwiler, G. R., Gress, D. R., & CARAT Investigators. (2008). Predictors of Rehemorrhage After Treatment of Ruptured Intracranial Aneurysms: The Cerebral Aneurysm Rerupture After Treatment (CARAT) Study. Stroke, 39(1), 120-125. https://doi.org/10.1161/STROKEAHA.107.495747
Mitchell, P. J., Muthusamy, S., Dowling, R., & Yan, B. (2013). Does Small Aneurysm Size Predict Intraoperative Rupture during Coiling in Ruptured and Unruptured Aneurysms? Journal of Stroke and Cerebrovascular Diseases, 22(8), 1298-1303. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.10.017
Kawabata, S., Imamura, H., Adachi, H., Tani, S., Tokunaga, S., Funatsu, T., Suzuki, K., & Sakai, N. (2018). Risk factors for and outcomes of intraprocedural rupture during endovascular treatment of unruptured intracranial aneurysms. Journal of NeuroInterventional Surgery, 10(4), 362-366. https://doi.org/10.1136/neurintsurg-2017-013156
Imamura, H., Sakai, N., Satow, T., Iihara, K., & JR-NET3 Study Group. (2020). Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms. Journal of NeuroInterventional Surgery, 12(6), 605-609. https://doi.org/10.1136/neurintsurg-2019-015459
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
