NDLI: Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling.

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Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kung, David K. Policeni, Bruno A. Capuano, Ana W. Rossen, James D. Jabbour, Pascal M. Torner, James C. Howard, Matthew A. Hasan, David
Description	Country affiliation: United States Author Affiliation: Kung DK ( Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. david-kung@uiowa.edu)
Abstract	OBJECT: Intracranial stenting has improved the ability to treat wide-neck aneurysms via endovascular techniques. However, stent placement necessitates the use of antiplatelet agents, and the latter may complicate the treatment of patients with acutely ruptured aneurysms who demonstrate hydrocephalus and require ventriculostomy. Antiplatelet agents in this setting could increase the incidence of ventriculostomy-related hemorrhagic complications, but there are insufficient data in the medical literature to quantify this potential risk. The aim of this study was to directly quantify the risk of ventriculostomy-related hemorrhage in patients with acute aneurysmal subarachnoid hemorrhage treated with stent-assisted coiling. METHODS: The authors retrospectively identified 131 patients who underwent endovascular treatment for an acutely ruptured aneurysm as well as ventriculostomy or ventriculoperitoneal (VP) shunt placement. The rate of hemorrhagic complications associated with ventriculostomy or VP shunt insertion was compared between patients who underwent coiling without a stent (Group 1) and those who underwent stent-assisted coiling and dual antiplatelet therapy (Group 2). RESULTS: One hundred nine ventriculostomies or VP shunt placement procedures were performed in 91 patients in Group 1, and 50 procedures were undertaken in 40 patients in Group 2. The rates of radiographic hemorrhage and symptomatic hemorrhage were significantly higher in Group 2 (32% vs 14.7%, p = 0.02; and 8% vs 0.9%, p = 0.03, respectively). On multivariate analyses, Group 2 had 3.42 times the odds of a radiographic hemorrhage (95% CI 1.46-8.04, p = 0.0048) after adjusting for antiplatelet use prior to admission. CONCLUSIONS: The application of dual antiplatelet therapy in stent-assisted coiling of acutely ruptured aneurysms is associated with an increase in the risk of hemorrhagic complications following ventriculostomy or VP shunt placement, as compared with its use in a coiling procedure without a stent.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	4
Volume Number	114
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2011-04-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Intracranial Aneurysm Surgery Postoperative Hemorrhage Epidemiology Stents Ventriculostomy Adverse Effects Aneurysm, Ruptured Complications Endovascular Procedures Platelet Aggregation Inhibitors Therapeutic Use Retrospective Studies Risk Factors Sex Factors Subarachnoid Hemorrhage Pathology Tomography, X-ray Computed Ventriculoperitoneal Shunt
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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