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KMID : 1005420170190030162
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Journal of Cerebrovascular and Endovascular Neurosurgery
2017 Volume.19 No. 3 p.162 ~ p.170
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Procedure-related Complications during Endovascular Treatment of Intracranial Saccular Aneurysms
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Ahn Jae-Min
Oh Jae-Sang
Yoon Seok-Mann
Shim Jae-Hyun
Oh Hyuk-Jin
Bae Hack-Gun
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Abstract
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Objective : We evaluate the rates and outcomes of major procedure-related complications during coiling. Materials and
Methods : Between 2007 and 2015, 436 intracranial saccular aneurysms were treated. Complications are categorized as three types: intraprocedural aneurysm rupture (IAR), thromboembolism (TE), and post-procedural early rebleeding (PER). And we evaluated the risk factors of procedure related complications by multivariate analysis.
Results : Complications occurred in 61 aneurysms (14%). The overall incidence of complications in subarachnoid hemorrhage (SAH) was significantly higher than in unruptured intracranial aneurysm (UIA) (20% vs. 6%). The incidence of IAR and TE were higher in SAH than in UIA (IAR 12% vs. 4%, TE 7% vs. 3%, p < 0.05). Five PER occurred only in SAH. In 34 UIA which were treated with balloon-assisted coiling (BAC), all these patients had good recovery despite 3 patients had the IAR. The incidence of IAR and TE were not different between BAC and non-BAC groups (p > 0.05). All 7 patients who had IAR during BAC had good recovery. In multiple logistic regression analysis, female gender, SAH, and intraventricular hemorrhage were associated with procedure related complication (p < 0.05).
Conclusion : Endovascular coil embolization is a minimally invasive procedure, but incidence of its complication is not low, especially in SAH. BAC can be a good tool to avoid poor outcome from unexpected IAR during coiling. While IA tirofiban injection is a useful therapy in TE during coiling, sometimes we are aware of the risk of the early rebleeding in SAH patients.
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KEYWORD
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Aneurysm, Coil embolization, Intraprocedural aneurysm rupture, Thromboembolism
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