American Journal of Neuroradiology, Vol 19, Issue 1 157-165, Copyright © 1998 by American Society of Neuroradiology
ARTICLES |
Local intraarterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracerebral aneurysm: a comparison of anatomic results and clinical outcome
M Cronqvist, L Pierot, A Boulin, C Cognard, L Castaings and J Moret
Department of Neuroradiology, University Hospital, Lund, Sweden.
PURPOSE: We describe our therapeutic strategy and correlate the anatomic results and clinical outcomes in patients who received immediate fibrinolytic therapy for thromboembolic complications occurring during endovascular treatment of an intracerebral aneurysm. METHODS: The medical records and angiographic examinations of 19 patients were reviewed. All endovascular procedures were performed with the patients under general anesthesia and fully heparinized. Thirteen patients received an intravenous bolus injection of aspirin. Thromboemboli occurred during catheterization or insertion of embolic material (Guglielmi detachable coils or mechanical detachable spirals) or in the first hours after the intervention. Clot distribution was within the MCA territory in 14 patients, the ACA in three patients, and the basilar trunk in two patients. A continuous intraarterial injection of urokinase was administered immediately, either superselectively distal to the thrombus or selectively within or closely proximal to the thrombus. In nine cases, chemical lysis was combined with mechanical clot fragmentation. Initial anatomic recanalization as well as clinical outcome at 3 months were evaluated. RESULTS: Ten patients showed complete recanalization and nine patients showed partial recanalization. Fourteen patients had a good clinical recovery. One patient was moderately disabled and two were severely disabled according to their scores on the Glasgow outcome scale. Two patients died, one as a consequence of the preexisting subarachnoid hemorrhage and the other because of a large intracerebral hematoma that developed after fibrinolysis. Of the 14 patients with a good clinical outcome, nine exhibited complete recanalization and five partial recanalization. CONCLUSION: Pharmacological thrombolysis seems to be a safe and efficient therapy that facilitates the natural fibrinolytic process, increasing the rate of recanalization in thromboembolic events. Clot fragmentation and superselective drug infusion appear to improve the rate of recanalization. Complete recanalization increases the chance of a better clinical outcome; however, clinical outcome does not always correspond to recanalization and vice versa.
This article has been cited by other articles:
 |
|
 |
|
  R.G. Jones, I. Davagnanam, S. Colley, R.J. West, and D.A. Yates Abciximab for Treatment of Thromboembolic Complications during Endovascular Coiling of Intracranial Aneurysms AJNR Am. J. Neuroradiol., November 1, 2008; 29(10): 1925 - 1929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Katsaridis, C. Papagiannaki, N. Skoulios, I. Achoulias, and D. Peios Local Intra-Arterial Eptifibatide for Intraoperative Vessel Thrombosis during Aneurysm Coiling AJNR Am. J. Neuroradiol., August 1, 2008; 29(7): 1414 - 1417. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y.-S. Guan and M.-Q. Wang Endovascular Embolization of Intracranial Aneurysms Angiology, July 1, 2008; 59(3): 342 - 351. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Arnold, U. Fischer, G. Schroth, K. Nedeltchev, J. Isenegger, L. Remonda, S. Windecker, C. Brekenfeld, and H. P. Mattle Intra-arterial Thrombolysis of Acute Iatrogenic Intracranial Arterial Occlusion Attributable to Neuroendovascular Procedures or Coronary Angiography Stroke, May 1, 2008; 39(5): 1491 - 1495. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Aleu, P. Mellado, C. Lichy, M. Kohrmann, and P. D. Schellinger Hemorrhagic Complications After Off-Label Thrombolysis for Ischemic Stroke Stroke, February 1, 2007; 38(2): 417 - 422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.J. Yi, R. Gupta, T.G. Jovin, A. Tayal, J. Genevro, Y. Gologorsky, and M. Horowitz Initial Experience with the Use of Intravenous Eptifibatide Bolus during Endovascular Treatment of Intracranial Aneurysms. AJNR Am. J. Neuroradiol., October 1, 2006; 27(9): 1856 - 1860. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.J. van Rooij, M. Sluzewski, G.N. Beute, and P.C. Nijssen Procedural Complications of Coiling of Ruptured Intracranial Aneurysms: Incidence and Risk Factors in a Consecutive Series of 681 Patients AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1498 - 1501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bruening, S. Mueller-Schunk, D. Morhard, K.C. Seelos, H. Brueckmann, R. Schmid-Elsaesser, A. Straube, and T.E. Mayer Intraprocedural Thrombus Formation during Coil Placement in Ruptured Intracranial Aneurysms: Treatment with Systemic Application of the Glycoprotein IIb/IIIa Antagonist Tirofiban AJNR Am. J. Neuroradiol., June 1, 2006; 27(6): 1326 - 1331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Doerfler, I. Wanke, S.L. Goericke, H. Wiedemayer, T. Engelhorn, E.R. Gizewski, D. Stolke, and M. Forsting Endovascular Treatment of Middle Cerebral Artery Aneurysms with Electrolytically Detachable Coils AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 513 - 520. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Chapot, M. Wassef, A. Bisdorff, A. Rogopoulos, J.-J. Merland, and E. Houdart Occlusion of the Middle Cerebral Artery due to Synthetic Fibers AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 148 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. I. Aviv, R. O'Neill, M. C. Patel, and I. R. Colquhoun Abciximab in Patients with Ruptured Intracranial Aneurysms AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1744 - 1750. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-K. Park, M. Horowitz, C. Jungreis, J. Genevro, C. Koebbe, E. Levy, and A. Kassam Periprocedural Morbidity and Mortality Associated with Endovascular Treatment of Intracranial Aneurysms AJNR Am. J. Neuroradiol., March 1, 2005; 26(3): 506 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Flett, C. S. Chandler, D. Giddings, and A. Gholkar Aneurysmal Subarachnoid Hemorrhage: Management Strategies and Clinical Outcomes in a Regional Neuroscience Center AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 367 - 372. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Song, Y. Niimi, P. M. Fernandez, J. L. Brisman, R. Buciuc, M. J. Kupersmith, and A. Berenstein Thrombus Formation during Intracranial Aneurysm Coil Placement: Treatment with Intra-Arterial Abciximab AJNR Am. J. Neuroradiol., August 1, 2004; 25(7): 1147 - 1153. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. H. Yu, M. S. Y. Chan, R. Boet, J. K. T. Wong, J. M. K. Lam, and W. S Poon Intracranial Aneurysms Treated with Guglielmi Detachable Coils: Midterm Clinical and Radiological Outcome in 97 Consecutive Chinese Patients in Hong Kong AJNR Am. J. Neuroradiol., February 1, 2004; 25(2): 307 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Mounayer, M. Piotin, S. Baldi, L. Spelle, and J. Moret Intraarterial Administration of Abciximab for Thromboembolic Events Occurring during Aneurysm Coil Placement AJNR Am. J. Neuroradiol., November 1, 2003; 24(10): 2039 - 2043. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Qureshi Editorial Comment--Thromboembolic Events During Neuroendovascular Procedures Stroke, July 1, 2003; 34(7): 1728 - 1729. [Full Text] [PDF]
|
|
|
|
|
|
S. Hahnel, P. D. Schellinger, A. Gutschalk, K. Geletneky, M. Hartmann, M. Knauth, and K. Sartor Local Intra-arterial Fibrinolysis of Thromboemboli Occurring During Neuroendovascular Procedures With Recombinant Tissue Plasminogen Activator Stroke, July 1, 2003; 34(7): 1723 - 1728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Fourie and I. C. Duncan Microsnare-Assisted Mechanical Removal of Intraprocedural Distal Middle Cerebral Arterial Thromboembolism AJNR Am. J. Neuroradiol., April 1, 2003; 24(4): 630 - 632. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Han, O-K. Kwon, C. J. Yoon, B. J. Kwon, S. H. Cha, and K.-H. Chang Gas Generation and Clot Formation during Electrolytic Detachment of Guglielmi Detachable Coils: In Vitro Observations and Animal Experiment AJNR Am. J. Neuroradiol., March 1, 2003; 24(3): 539 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Workman, H. J. Cloft, F. C. Tong, J. E. Dion, M. E. Jensen, W. F. Marx, and D. F. Kallmes Thrombus Formation at the Neck of Cerebral Aneurysms during Treatment with Guglielmi Detachable Coils AJNR Am. J. Neuroradiol., October 1, 2002; 23(9): 1568 - 1576. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. P. Ng, C. C. Phatouros, and M. S. Khangure Use of Glycoprotein IIb-IIIa Inhibitor for a Thromboembolic Complication during Guglielmi Detachable Coil Treatment of an Acutely Ruptured Aneurysm AJNR Am. J. Neuroradiol., October 1, 2001; 22(9): 1761 - 1763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Roy, G. Milot, and J. Raymond Endovascular Treatment of Unruptured Aneurysms Stroke, September 1, 2001; 32(9): 1998 - 2004. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Pillai, C. F. Lanzieri, S. B. Trinidad, R. W. Tarr, J. L. Sunshine, and J. S. Lewin Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute Stroke as a Predictor of Outcome of Thrombolysis: Initial Experience Radiology, March 1, 2001; 218(3): 733 - 738. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. Piotin, S. Mandai, K. Sugiu, P. Gailloud, and D. A. Rüfenacht Endovascular Treatment of Cerebral Aneurysms: An In Vitro Study with Detachable Platinum Coils and Tricellulose Acetate Polymer Am. J. Roentgenol., January 1, 2001; 176(1): 235 - 239. [Abstract] [Full Text]
|
|
|
|
|
|
A. Biondi, C. Oppenheim, E. Vivas, A. Casasco, T. Lalam, N. Sourour, L. L. Jean, D. Dormont, and C. Marsault Cerebral Aneurysms Treated by Guglielmi Detachable Coils: Evaluation with Diffusion-weighted MR Imaging AJNR Am. J. Neuroradiol., May 1, 2000; 21(5): 957 - 963. [Abstract] [Full Text]
|
|
|
|
|
|
N. Saito, N. Hayashi, T. Okubo, K. Takai, H. Miyauchi, T. Sasaki, and T. Kirino Internal Carotid Artery Aneurysm Visualized during Successful Endovascular Treatment of Carotid Embolism AJNR Am. J. Neuroradiol., March 1, 2000; 21(3): 546 - 548. [Abstract] [Full Text]
|
|
|
|
|
|
T. E. Lempert, A. M. Malek, V. V. Halbach, C. C. Phatouros, C. F. Dowd, and R. T. Higashida Rescue Treatment of Acute Parent Vessel Thrombosis With Glycoprotein IIb/IIIa Inhibitor During GDC Coil Embolization Stroke, March 1, 1999; 30 (3): 693 - 695. [Full Text] [PDF]
|
|