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Partial coil embolization before surgical clipping of ruptured intracranial aneurysms.
Mistry, Akshitkumar M; Naidugari, Janki; Meyer, Kimberly S; Chen, Ching-Jen; Williams, Brian J; Morton, Ryan P; Abecassis, Isaac J; Ding, Dale.
Afiliação
  • Mistry AM; Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, 15th Floor, Louisville, KY, 40202, USA. axitamm@gmail.com.
  • Naidugari J; School of Medicine, University of Louisville, Louisville, KY, USA.
  • Meyer KS; Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, 15th Floor, Louisville, KY, 40202, USA.
  • Chen CJ; Department of Neurosurgery, University of Texas Health Science Center, Houston, TX, USA.
  • Williams BJ; Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, 15th Floor, Louisville, KY, 40202, USA.
  • Morton RP; Division of Neurosurgery, Brooke Army Medical Center, San Antonio, TX, USA.
  • Abecassis IJ; Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, 15th Floor, Louisville, KY, 40202, USA.
  • Ding D; Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, 15th Floor, Louisville, KY, 40202, USA.
Acta Neurochir (Wien) ; 166(1): 293, 2024 Jul 10.
Article em En | MEDLINE | ID: mdl-38985334
ABSTRACT

OBJECTIVE:

Intraoperative rupture (IOR) is the most common adverse event encountered during surgical clip obliteration of ruptured intracranial aneurysms. Besides increasing surgeon experience and early proximal control, no methods exist to decrease IOR risk. Thus, our objective was to assess if partial endovascular coil embolization to protect the aneurysm before clipping decreases IOR.

METHODS:

We conducted a retrospective analysis of patients with ruptured intracranial aneurysms that were treated with surgical clipping at two tertiary academic centers. We compared patient characteristics and outcomes of those who underwent partial endovascular coil embolization to protect the aneurysm before clipping to those who did not. The primary outcome was IOR. Secondary outcomes were inpatient mortality and discharge destination.

RESULTS:

We analyzed 100 patients. Partial endovascular aneurysm protection was performed in 27 patients. Age, sex, subarachnoid hemorrhage severity, and aneurysm location were similar between the partially-embolized and non-embolized groups. The median size of the partially-embolized aneurysms was larger (7.0 mm [interquartile range 5.95-8.7] vs. 4.6 mm [3.3-6.0]; P < 0.001). During surgical clipping, IOR occurred less frequently in the partially-embolized aneurysms than non-embolized aneurysms (2/27, 7.4%, vs. 30/73, 41%; P = 0.001). Inpatient mortality was 14.8% (4/27) in patients with partially-embolized aneurysms and 28.8% (21/73) in patients without embolization (P = 0.20). Discharge to home or inpatient rehabilitation was 74.0% in patients with partially-embolized aneurysms and 56.2% in patients without embolization (P = 0.11). A complication from partial embolization occurred in 2/27 (7.4%) patients.

CONCLUSIONS:

Preoperative partial endovascular coil embolization of ruptured aneurysms is associated with a reduced frequency of IOR during definitive treatment with surgical clip obliteration. These results and the impact of preoperative partial endovascular coil embolization on functional outcomes should be confirmed with a randomized trial.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Aneurisma Intracraniano / Aneurisma Roto / Embolização Terapêutica Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Acta Neurochir (Wien) Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Áustria

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Aneurisma Intracraniano / Aneurisma Roto / Embolização Terapêutica Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Acta Neurochir (Wien) Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Áustria