Risk factors for coil protrusion into the parent artery and associated thrombo-embolic events following unruptured cerebral aneurysm embolization

Abstract

Objective

Advances in vascular reconstruction devices and coil technologies have made coil embolization a popular and effective strategy for treatment of relatively wide-neck cerebral aneurysms. However, coil protrusion occurs occasionally, and little is known about the frequency, the risk factors and the risk of thrombo-embolic complications.

Method

We assessed the frequency and the risk factors for coil protrusion in 330 unruptured aneurysm embolization cases, and examined the occurrence of cerebral infarction by diffusion-weighted magnetic resonance imaging (DW-MRI).

Result

Forty-four instances of coil protrusion were encountered during coil embolization (13.3% of cases), but incidence was reduced to 33 (10% of cases) by balloon press or insertion of the next coil. Coil protrusion occurred more frequently during the last phase of the procedure, and both a wide neck (large fundus to neck ratio) (OR = 1.84, P = 0.03) and an inadequately stable neck frame (OR = 5.49, P = 0.0007) increased protrusion risk. Coil protrusions did not increase the incidence of high-intensity lesions (infarcts) on DW-MRI (33.3% vs 29% of cases with no coil protrusion). However, longer operation time did increase infarct risk (P = 0.0003). Thus, tail or loop type coil protrusion did not increase the risk of thrombo-embolic complications, if adequate blood flow was maintained.

Conclusion

Coil protrusion tended to occur more frequently in cases of wide-neck aneurysms with loose neck framing. Moderate and less coil protrusion carries no additional thrombo-embolic risk, if blood flow is maintained, which can be aided by additional post-operative antiplatelet therapy.

Keywords

Coil protrusion thrombo-embolic complication cerebral aneurysm

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References

Abdihalim

Kim

Maud

. Short- and intermediate-term angiographic and clinical outcomes of patients with various grades of coil protrusions following embolization of intracranial aneurysms. Am J Neuroradiol 2011; 32: 1392–1398.

Sourour

Gongora-Rivera

Biondi

. Additional rescue stent placement for stabilization of a prolapsed coil during stent-assisted coil embolization of a wide-neck intracranial aneurysm. Interv Neuroradiol 2006; 12: 257–262.

Yonaha

Hyodo

Inaji

. Thromboembolic events associated with coil protrusion into parent arteries after GDC treatment. Interv Neuroradiol 2006; 12: 105–111.

Yamao

Satow

Murao

. Research of postoperative complications after coil protrusions in embolization of unruptured cerebral aneurysms. No Shinkei Geka 2012; 40: 23–29.

Hayashi

Horie

Morikawa

. Case of an internal carotid artery aneurysm complicated with coil protrusion during embolization. No Shinkei Geka 2012; 40: 271–276.

Soeda

Sakai

. Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. Am J Neuroradiol 2003; 24: 127–132.

Matsumoto

Kondo

Matsumori

. Antiplatelet therapy for prevention of thromboembolic complications associated with coil embolization of unruptured cerebral aneurysms. Drugs R D 2012; 12: 1–7.

Wilson

Pandey

Stetler

Jr . Dual antiplatelet therapy plus postoperative heparin and dextran is safe and effective for reducing risk of embolic stroke during aneurysm coiling. Acta Neurochir 2014; 156: 855–859.