Thromboembolic Events after Coil Embolization of Cerebral Aneurysms : Prospective Study with Diffusion-Weighted Magnetic Resonance Imaging Follow-up

  • Chung, Seok-Won (Department of Neurosurgery Kyungpook National University Hospital) ;
  • Baik, Seung-Kug (Department of Neuroradiology Kyungpook National University Hospital) ;
  • Kim, Yong-Sun (Department of Neuroradiology Kyungpook National University Hospital) ;
  • Park, Jae-Chan (Department of Neurosurgery Kyungpook National University Hospital)
  • 발행 : 2008.06.13

초록

Objective : In order to assess the incidence of thromboembolic events and their clinical presentations, the present study prospectively examined routine brain magnetic resonance images (MRI) taken within 48 hours after a coil embolization of cerebral aneurysms. Methods : From January 2006 to January 2008, 163 cases of coil embolization of cerebral aneurysm were performed along with routine brain MRI, including diffusion-weighted magnetic resonance (DW-MR) imaging, within 48 hours after the embolization of the aneurysm to detect the silent thromboembolic events regardless of any neurological changes. If any neurological changes were observed, an immediate brain MRI follow-up was performed. High-signal-intensity lesions in the DW-MR images were considered as acute thromboembolic events and the number and locations of the lesions were also recorded. Results : Among the 163 coil embolization cases, 98(60.1%) showed high-signal intensities in the DW-MR imaging follow-up, 66 cases (67.0%) involved the eloquent area and only 6cases (6.0%) showed focal neurological symptoms correlated to the DW-MR findings. The incidence of DW-MR lesions was higher in older patients (${\geq}60$ yrs) when compared to younger patients (<60 yrs) (p=0.002, odd's ratio=1.043). The older patients also showed a higher incidence of abnormal DW-MR signals in aneurysm-unrelated lesions (p=0.0003, odd's ratio=5.078). Conclusion : The incidence of symptomatic thromboembolic attacks after coil embolization of the cerebral aneurysm was found to be lower than that reported in previous studies. While DW-MR imaging revealed a higher number of thromboembolic events, most of these were clinically silent and transient and showed favorable clinical outcomes. However, the incidence of DW-MR abnormalities was higher in older patients, along with unpredictable thromboembolic events on DW-MR images. Thus, in order to provide adequate and timely treatment and to minimize neurological sequelae, a routine DW-MR follow-up after coil embolization of cerebral aneurysms might be helpful, especially in older patients.

키워드

참고문헌

  1. Biondi A, Oppenheim C, Vivas E, Casasco A, Lalam T, Sourour N, et al : Cerebral aneurysms treated by Guglielmi detachable coils : evaluation with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 21 : 957-963, 2000
  2. Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A : Treatment of intracranial aneurysm by embolization with coils : a systemic review. Stroke 30 : 470-476, 1999 https://doi.org/10.1161/01.STR.30.2.470
  3. Byrne JV, Sohn MJ, Molyneux AJ, Chir B : Five-year experience in using coil embolization for ruptured intracranial aneurysm : outcomes and incidence of late rebleeding. J Neurosurg 90 : 656-663, 1999 https://doi.org/10.3171/jns.1999.90.4.0656
  4. Cognard C, Weill A, Castaings L, Rey A, Moret J : Intracranial berry aneurysm : angiographic and clinical results after endovascular treatment. Radiology 206 : 499-510, 1998 https://doi.org/10.1148/radiology.206.2.9457205
  5. Derdeyn CP, Cross DT 3rd, Moran CJ, Brown GW, Pilgram TK, Diringer MN, et al : Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 96 : 837-843, 2002 https://doi.org/10.3171/jns.2002.96.5.0837
  6. Friedman JA, Nichols DA, Meyer FB, Pichelmann MA, McIver JI, Toussaint LG 3rd, et al : Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms : retrospective review of a 10- year single-center experience. AJNR Am J Neuroradiol 24 : 526- 533, 2003
  7. Kim JS, Byun HS, Kim KJ, Lee JI, Hong SC, Shin HJ, et al : Coil embolization of intracranial aneurysm : the effectiveness and limitation. J Korean Neurosurg Soc 27 : 749-756, 1998
  8. Ko JK, Choi CH, Lee TH, Baik SK : Endovascular treatment of cerebral aneurysm with Guglielmi detachable coils : retrospective review of a 4-year experience. J Korean Neurosurg Soc 34 : 419- 426, 2003
  9. Latchaw RE : Acutely ruptured intracranial aneurysm: should we treat with endovascular coils or with surgical clipping? Radiology 211 : 306-308, 1999 https://doi.org/10.1148/radiology.211.2.r99ma33306
  10. Leber KA, Klein GE, Trummer M, Eder HG : Intracranial aneurysms : a review of endovascular and surgical treatment in 248 patients. Minim Invasive Neurosurg 41 : 81-85, 1998 https://doi.org/10.1055/s-2008-1052022
  11. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al : Guglielmi detachable coil embolization of cerebral aneurysms : 11 years' experience. J Neurosurg 98 : 959-966, 2003 https://doi.org/10.3171/jns.2003.98.5.0959
  12. Pelz DM, Lownie SP, Fox AJ : Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 19 : 1541-1547, 1998
  13. Qureshi AI, Suri MF, Khan J, Kim SH, Fessler RD, Ringer AJ, et al : Endovascular treatment of intracranial aneurysms by using Guglielmi detachable coils in awake patients : safety and feasibility. J Neurosurg 94 : 880-885, 2001 https://doi.org/10.3171/jns.2001.94.6.0880
  14. Raymond J, Roy D : Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41 : 1235-1245 ; discussion 1245-1246, 1997 https://doi.org/10.1097/00006123-199712000-00002
  15. Rhee DY, Kim SY : Controversies in the coil embolization of intracranial aneurysms. J Korean Neurosurg Soc 28 : 1220-1225, 1999
  16. Rhee JW, Lee MS, Whang K, Pyen JS, Hu C, Hong SK : Complications of endovascular detachable coil treatment in cerebral aneurysms. J Korean Neurosurg Soc 35 : 173-177, 2004
  17. Rordorf G, Bellon RJ, Budzik RE, Farkas J, Reinking GF, Pergolizzi RS, et al : Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils : prospective study applying diffusionweighted imaging. AJNR Am J Neuroradiol 22 : 5-10, 2001
  18. Shanno GB, Armonda RA, Benitez RP, Rosenwasser RH : Assessment of acutely unsuccessful attempts at detachable coiling in intracranial aneurysms. Neurosurgery 48 : 1066-1072 ; discussion 1072-1074, 2001 https://doi.org/10.1097/00006123-200105000-00019
  19. Shindo A, Sakai N, Sakai H, Higashi T, Nagata I, Kikuchi H : [Problems involved in endovascular embolization of intracranial aneurysms with three-dimensional Gugliel mi detachable coils.] No Shinkei Geka 29 : 815-820, 2001
  20. Soeda A, Sakai N, Sakai H, Iihara K, Yamada N, Imakita S, et al : Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms : evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol 24 : 127-132, 2003
  21. Studley MT, Robinson DH, Howe JF : Delayed thromboembolic events 9 weeks after endovascular treatment of an anterior communicating artery aneurysm : case report. AJNR Am J Neuroradiol 23 : 975-977, 2002
  22. Vinuela F, Duckwiler G, Mawad M : Guglielmi detachable coil embolization of acute intracerebral aneurysm : perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86 : 475-482, 1997 https://doi.org/10.3171/jns.1997.86.3.0475
  23. Workman MJ, Cloft HJ, Tong FC, Dion JE, Jensen ME, Marx WF, et al : Thrombus formation at the neck of cerebral aneurysms during treatment with Guglielmi detachable coils. AJNR Am J Neuroradiol 23 : 1568-1576, 2002