Perioperative complication of unruptured cerebral aneurysms treated by endovascular coil embolization

Abstract

Objective: Perioperative complications from embolization of unruptured cerebral aneurysms in one institute serial series were analyzed. Subjects: From 1997.6 to 2007.6, 127 cases of unruptured cerebral aneurysm were treated by endosaccular coil embolization at one institute. They consisted of 34 paraclinoid internal carotid, 21 posterior communicating, 13 other internal carotid, 15 middle cerebral, 20 anterior communicating, 6 other anterior cerebral artery, and 18 posterior circulation aneurysms. Number of patients was categorized by size of aneurysm (less than 5mm: 38, 5-10mm: 81, and greater than 10mm: 8 cases). 68 patients received an antiplatelet agent principally preoperatively, and an additional secondary antiplatelet agent was given to those treated by balloon neck plasty. Results: Neurologically symptomatic complications were TIA in 2 (1.6%), and minor cerebral infarction in 2 patients (1.6%). Subarachnoid hemorrhage due to vessel perforation by guidewire occurred in 1 patient (0.8%). Putaminal hemorrhage occurred in 1 patient (0.8%) at 11 days after treatment. Other complications were upper gastrointestinal bleeding requiring blood transfusion in 2 patients (1.6%) and puncture- site pseudo-aneurysm requiring surgical repair in 1 patient (0.8%). Conclusion: Persistent neurological symptoms were observed in 3 patients (2.4%; mRS 1:1 and mRS 2:2), suggesting that complication rates for endovascular techniques are low or the same as previously reported surgical or endovascular series. These results indicate that endovascular coil embolization is a suitable alternative treatment for unruptured aneurysms. However, hemorrhagic complications related to the use of antiplatelet agents or anticoagulants are not negligible and require careful consideration. © 2008, The Japanese Society for Neuroendovascular Therapy. All rights reserved.