Outcome of intraoperative heparinization during stent-assisted coiling for unruptured aneurysms

Abstract

In this study, we aimed to compare the treatment outcomes of patients with unruptured aneurysms treated using stent-assisted coil embolization with and without systemic heparinization to examine the intraoperative systemic heparinization efficacy. We included 106 consecutive patients enrolled at Fukuoka Neurosurgical Hospital, Japan, between November 2021 and March 2023. The patients were divided into two groups: the systemic heparinization and nonsystemic heparinization groups. Head magnetic resonance imaging (MRI) performed on postoperative day 1 showed that the number of ischemic foci <2 mm was higher in the nonsystemic heparinization group than in the systemic heparinization group, although the difference was not statistically significant (2 [0–6] vs 1 [0–3], P = .0583). No significant between-group difference was observed concerning the incidence of ischemic and hemorrhagic complications. There was no significant between-group difference regarding the modified Rankin scale (mRS) score; however, the systemic heparinization group had a higher proportion of patients with poor outcomes than did the nonsystemic heparinization group, with one (2.4%) patient with an mRS score of 5 and one (2.4%) patient with an mRS score of 6. In conclusion, intraoperative systemic heparinization during stent-assisted coil embolization of unruptured cerebral aneurysms may suppress diffusion-weighted imaging high-signal spots on head MRI performed on postoperative day 1. Moreover, systemic heparinization may worsen the outcomes of hemorrhagic complications.