Joo Yeon Lee, Presenter: Nothing to Disclose

Jung Cheol Park, Abstract Co-Author: Nothing to Disclose

Jae Kyun Kim MD, Abstract Co-Author: Nothing to Disclose

Dae Yoon Kim, Abstract Co-Author: Nothing to Disclose

Choong Gon Choi MD, Abstract Co-Author: Nothing to Disclose

Deok Hee Lee MD, Abstract Co-Author: Nothing to Disclose

To analyze the incidence and risk factors of microembolic lesions on diffusion-weighted imaging (DWI) after endovascular coiling of unruptured intracranial aneurysms.

From Jul. 2011 to Jun. 2013, we had 271 consecutive cases (70 men and 201 women, median age of 57 with a range of 23-79) of unruptured aneurysm embolization. Aneurysm location was in the anterior circulation in 226 and posterior circulation in 45. Multiple aneurysms were seen in 37. Maximum diameter of the index aneurysm was 5 mm in median (range: 2.2-21). Procedures were done by simple coiling (n=91), stent assisted (n=105), balloon assisted (n=16), or multiple microcatheters (n=59) using various types of detachment coils. Total number of coils was 5 in median (range, 2-23). Procedure duration ranged from 20 to 235 (median, 61) minutes. Any coil loop herniation was seen in 37. Overt thromboembolic phenomenon which required use of thrombolytics was noted in 5. Intra-procedural rupture occurred in 4. DWI was obtained the following day to see occurrence of any microembolic lesion. 2 independent reviewers were analyzed the presence of any microembolic lesion and counted the lesion number. Multivariate analysis was done to find independent risk factors of microembolism.

Microembolic lesions were noted in 101 (37.3%). The number was less than 5 in 70.3%. Multivariate analysis showed various statistically significant factors which included age (OR: 1.04, p=0.01), diabetes (OR: 3.21, p=0.002), previous history of ischemic stroke (OR: 3.58, p=0.044), white matter FLAIR HSI (OR: 5.48, p=0.001), multiple aneurysms (OR:3.08, p=0.018), and stent-assisted technique with Enterprise stent (OR: 10.7, p<0.001) Previously known risk factors such as prolonged procedure duration, aneurysm size, or decreased antiplatelet function did not show any significant influence.

The incidence of DWI high signal lesions after coiling of unruptured aneurysms was not low even though most of them were asymptomatic. It occurred more frequently in patients with vulnerable vascular status. Multiplicity of aneurysm and stent type also influenced its occurrence.

Care should be taken to reduce the incidence of post-procedural microembolic lesions after coiling of unruputred cerebral aneurysms in patients with vulnerable vacular status.

Lee, J, Park, J, Kim, J, Kim, D, Choi, C, Lee, D, Microembolism after Endovascular Treatment of Unruptured Cerebral Aneurysms: Incidence and Risk Factor Analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018216.html