Literature Review

Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms

Selected in the Journal of NeuroInterventional Surgery by FERRAZ Fausto

Authors: Fan L, Lin B, Xu T, Xia N, Shao X, Tan X, Zhong M, Yang Y, Zhao B

Reference: J Neurointerv Surg. 2017 Apr;9(4):370-375

Published: April 2017

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Tuesday 23 May 2017

The major complications related to ruptured ACoA aneurysms coiling occur due to aneurysm perforation or thrombus formation. These are important issues related to this location, especially for small aneurysms, and they should be highly considered during the treatment planning.

That was the main conclusion of this paper which involved 231 ACoA aneurysms treated in acute SAH phase during 7 years, in order to identify independent predictors of higher risk for those complications. The population was separated into rupture / no-rupture and thrombus / no-thrombus groups. Intracranial stents were involved in the treatment strategy for dome/neck considerations.

Results showed 4.3% of intraprocedural rupture with narrower-neck and aneurysms smaller than 3 mm being mainly associated to it. Thrombus formation occurred in 6.5% of patients and was related to wide neck aneurysms, smaller parent vessel angles (60o), smaller dome to neck ratio and stent-assisted coiling. The infusion of intravenous glycoprotein inhibitor was not available when stents were implanted during this study and might have been an issue to decrease the rate of thrombus formation.

In general death occurrs with higher prevalence when a rupture or thrombus happens. 

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