Microembolism after endovascular coiling of unruptured cerebral aneurysms: incidence and risk factors

J Neurosurg. 2016 Mar;124(3):777-83. doi: 10.3171/2015.3.JNS142835. Epub 2015 Sep 18.


Objective: The incidence and risk factors of microembolic lesions on MR diffusion-weighted imaging (DWI) were analyzed after the endovascular coiling of unruptured intracranial aneurysms (UIAs).

Methods: Data obtained from 271 consecutive patients (70 men and 201 women; median age 57 years; range 23-79 years) who presented with UIA for coil embolization between July 2011 and June 2013 were analyzed. Two independent reviewers examined the DWI and apparent diffusion coefficient maps obtained the following day for the presence of restrictive diffusion spots and counted the number of spots. Multivariate analysis was then performed to identify independent risk factors for developing microembolism following the coiling of an aneurysm.

Results: Microembolic lesions were noted in 101 of 271 patients (37.3%). The results of the multivariate analysis showed that the following factors significantly influenced the risk for microembolism: age, diabetes, previous history of ischemic stroke, high-signal FLAIR lesions in the white matter, multiple aneurysms, and the insertion of an Enterprise stent (all ORs > 1.0 and all p values < 0.05). Previously known risk factors such as prolonged procedure duration, aneurysm size, and decreased antiplatelet function did not show any significant influence.

Conclusions: The incidence of microembolism after endovascular coiling of UIA was not low. Lesions occurred more frequently in patients with vascular status associated with old age, diabetes, and previous stroke. Aneurysm multiplicity and the type of stent used for treatment also influenced lesion occurrence.

Keywords: ACT = activated clotting time; ADC = apparent diffusion coefficient; BMI = body mass index; DM = diabetes mellitus; DWI = diffusion-weighted imaging; HSI = high signal intensity; PRU = P2Y12 reaction unit; UIA= unruptured intracranial aneurysm; diffusion-weighted imaging; endovascular coiling; microembolism; unruptured cerebral aneurysm; vascular disorders.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Diffusion Magnetic Resonance Imaging
  • Embolization, Therapeutic*
  • Endovascular Procedures*
  • Female
  • Humans
  • Incidence
  • Intracranial Aneurysm / therapy*
  • Intracranial Embolism / epidemiology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Young Adult