Antiplatelet Premedication-Free Stent-Assisted Coil Embolization in Acutely Ruptured Aneurysms

Abstract

Objective: Stent-assisted coil embolization (SAC) is one of the treatment options for patients with intracranial aneurysms. The purpose of this study was to assess clinical outcomes of patients who underwent coil embolization for acutely ruptured aneurysms without antiplatelet premedication.

Methods: A total of 449 patients with acutely ruptured aneurysms underwent endovascular treatment without antiplatelet premedication between April 2006 and October 2015. Among them, 55 patients underwent SAC (SAC group) and 394 underwent coiling without stent assistance (non-SAC group). Periprocedural complications and clinical outcomes at postictal 6 months were compared between the 2 groups.

Results: The rate of hemorrhagic complications showed no significant difference (SAC group vs. non-SAC group, 9.1% vs. 4.8%). Although procedural thromboembolism occurred more frequently in the SAC group (25.5% vs. 12.4%; P = 0.01), poor clinical outcomes (modified Rankin scale score ≥3) were comparable (30.9% vs. 22.1%). In the multivariate analysis, Hunt-Hess grade (odds ratio [OR] = 4.22; P < 0.001), hemorrhagic complications (OR = 4.01; P = 0.018), and age (OR = 1.04, P = 0.001) were independent predictors of poor clinical outcomes, but stent-assisted coil embolization and procedural thromboembolism were not.

Conclusions: Although procedure-related thromboembolism occurred more frequently, comparable treatment outcomes could be achieved with antiplatelet premedication-free SAC in patients with acutely ruptured aneurysms. The use of stents and thromboembolic complications were not significant risk factors for poor clinical outcome.

Keywords: Acutely ruptured aneurysms; Antiplatelet premedication; Clinical outcomes; Hemorrhage; Stent-assisted coil embolization; Thromboembolism.