Maria Luise Hahnemann MD, Presenter: Nothing to Disclose

Marc U. Schlamann, Abstract Co-Author: Nothing to Disclose

Sophia Goericke, Abstract Co-Author: Nothing to Disclose

Christoph Moenninghoff MD, Abstract Co-Author: Nothing to Disclose

Michael Forsting MD, Abstract Co-Author: Nothing to Disclose

Isabel Wanke MD, Abstract Co-Author: Nothing to Disclose

Adrian Stefan Ringelstein MD, Abstract Co-Author: Nothing to Disclose

Stent-assisted coiling has improved the ability to treat difficult and complicated aneurysms. The present study aims at investigating the rate of embolic lesions after stent-assisted coiling and associated predictors.  

The study included a total of 75 patients electively treated with stent-assisted coiling. Postinterventional diffusion-weighted magnetic resonance imaging of the brain was performed to detect ischemic lesions. Demographic data (sex and age), aneurysm characteristics (aneurysm location, aneurysm size) and angiographic parameters (length of stent, number of coils, heparin administration) were correlated with properties of ischemic lesions.  

After stent-assisted coiling 48/75 diffusion-weighted magnetic resonance images revealed 163 bright lesions in a pattern consistent with embolic events. 142 lesions were < 5 mm in diameter, whereas 18 lesions were between 5-15 mm. Three lesions had a diameter > 15 mm. 27/75 patients showed no embolic events. 5 patients developed a new apparent neurological deficit after stent-assisted coiling, whereof four patients had a temporarily and one a remaining neurological deficit. The number of patients with lesions was significantly increased in patients ≥ 55 years (p=0.007) and with an intervention time ≥ 120 min (p=0.027). The ischemic brain volume was significantly increased in patients ≥ 55 years of age (p=0.0282) as well as in patients who got implanted a stent with a length ≥ 20 mm (p=0.0263).  

After stent-assisted coiling silent (non-symptomatic) embolic events are relatively frequent. Especially patients ≥ 55 years and patients with longer intervention times are at high risk. Furthermore, patients ≥ 55 years and patients who need a stent of ≥ 20 mm length might be assumed to be at higher risk to sustain clinical relevant lesions.  

New prevention possibilities should be improved to minimize the rates of silent lesions, and, presumably, the subsequent rate of neurological complications.

Hahnemann, M, Schlamann, M, Goericke, S, Moenninghoff, C, Forsting, M, Wanke, I, Ringelstein, A, Stent-assisted Coiling Is Associated with Thromboembolic Events: Evaluation of 75 Cases by Means of Diffusion-weighted Magnetic Resonance Imaging  .  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12022908.html