Thromboelastography 6s for assessment of platelet function during coil embolization of unruptured intracranial aneurysms

Efficacy and Safety of Adjunctive Coiling in Pipeline Embolization Device Implantation for Small- and Medium-Sized Unruptured Cerebral Aneurysms: A Retrospective Cohort Study and Literature Review

BACKGROUND

The pipeline embolization device with adjunctive coiling (PAC) for small- and medium-sized unruptured cerebral aneurysms (UCAs) has not yet been fully evaluated for promoting aneurysm occlusion and preventing delayed rupture. The present study investigated the efficacy and safety of the PAC for UCAs ≤10 mm in diameter.

METHODS

Fifty consecutive UCAs (50 patients) ≤10 mm in diameter that underwent flow diversion with a single pipeline embolization device (PED) at three institutions between January 2019 and January 2024 were retrospectively reviewed. Patients were divided into PAC- (n = 23) and PED-alone (n = 27) groups. Data were compared regarding embolization results and complications.

RESULTS

Aneurysms with bleb formation, medium-sized aneurysms (7-10 mm), and those treated via transfemoral access were significantly more frequently managed with PAC than PED alone. In the PAC group, Raymond-Roy Occlusion Classification scores immediately after treatment were class 1 in 1 case (4.3%) and class 3 in 22 cases (96%), with a mean volume embolization ratio of 20.6%. The PAC group had a significantly longer procedure time (184 vs. 117 minutes, P < 0.001) but showed no differences in ischemic or hemorrhagic complications, access site complications, or in-stent stenosis. Complete occlusion was significantly higher in the PAC group at 6 months (100% vs. 67%, P = 0.002) and 1 year (100% vs. 74%, P = 0.011). No delayed complications, including ischemic events, aneurysm rupture, or death, were observed in either group.

CONCLUSIONS

PAC for UCAs ≤10 mm in diameter may enhance the rate of complete occlusion without increasing the risk of complications.

Risk factors for intraoperative in-stent thrombosis during stent-assisted coiling of paraclinoid aneurysms

Objectives

To identify independent risk factors for intraoperative in-stent thrombosis (IST) in paraclinoid aneurysms (PAs).

Methods

172 PA patents undergoing stent-assisted coiling (SAC) were divided into an IST group (n = 12) and a non-IST group (n = 160). Clinical characteristics, aneurysm morphologies, and laboratory parameters were measured. We performed independent t tests (for normally distributed data) or non-parametric tests (for non-normally distributed data) to compare continuous parameters. Multivariate logistic regression analysis with a stepwise forward method was conducted to determine independent risk factors. Receiver operating characteristic curves were generated, and the Delong test was employed for comparisons.

Results

Independent risk factors for IST included size ratio (SR) (p < 0.001, odds ratio [OR] = 3.909, confidence interval [CI] = 1.925-7.939), adenosine diphosphate (ADP) inhibition (p = 0.028, OR = 0.967, CI = 0.938-0.996), and reaction time (R) (p = 0.006, OR = 0.326, CI = 0.147-0.725). The combined factors (SR, ADP inhibition, and R) exhibited area under the curves of 0.870, 0.720, 0.716, and 0.697, with cutoff values of 2.46, 69.90%, and 4.65, respectively.

Conclusion

The SR, ADP inhibition, and R values were independent risk factors for the IST in the PAs undergoing SAC. For PAs with a large SR, surgeons could prepare for long-term dual antiplatelet therapy before SAC.