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Letter

In Reply to Antiplatelet Therapy Prior to Temporary Stent-Assisted Coiling

B. Gory, F. Signorelli and F. Turjman
American Journal of Neuroradiology March 2016, 37 (3) E30; DOI: https://doi.org/10.3174/ajnr.A4661
B. Gory
aFHU IRIS, Department of Interventional Neuroradiology Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon Lyon, France
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F. Signorelli
bDepartment of Neurosurgery Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon Lyon, France
cDepartment of Experimental and Clinical Medicine University Magna Græcia Catanzaro, Italy
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F. Turjman
dFHU IRIS, Department of Interventional Neuroradiology Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon Lyon, France
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We would like to thank Drs Almekhlafi and Goyal for their comments1 concerning our article, “Temporary Solitaire Stent-Assisted Coiling: A Technique for the Treatment of Acutely Ruptured Wide-Neck Intracranial Aneurysms.”2

Almekhlafi et al noticed that we performed the procedures without preadministering antiplatelet therapy, and they would like to caution against the wide adoption of this technique without pretreatment with antiplatelet agents. They reported the endovascular treatment of 10 aneurysms (6 unruptured and 4 ruptured) in 8 patients by using temporary stent-assisted coiling. One of their patients with an unruptured aneurysm was not pretreated with dual antiplatelet therapy and presented with a procedural in-stent thrombosis with no clinical sequelae.

An antiplatelet regimen is usually administered before stent placement in selective cases. However, in our article,2 we reported our experience in a different situation (acutely ruptured aneurysms). In this setting, to the best of our knowledge, it seems clear that adverse events happen more commonly and clinical outcomes are likely to be worse than those achieved without stent assistance3; thus, we did not use antiplatelet therapy in our series. Recently, Bechan et al4 compared the rate of stent-placement complications in acutely ruptured versus unruptured aneurysms, and they have shown that the morbidity and mortality increased. Application of dual antiplatelet therapy in stent-assisted coiling of acutely ruptured aneurysms is associated with an increased risk of hemorrhagic complications following shunt placement,5 especially in middle cerebral artery and anterior communicating artery aneurysms.6 In our series, 4 of the 8 patients underwent emergent shunt placement and no hemorrhagic complication was noted.

As Drs Almekhlafi and Goyal noted, temporary stent-assisted coiling could be a helpful technique; however, it should be considered only when other endovascular techniques are not feasible, especially in the setting of acute ruptured aneurysms. The current literature does not support using antiplatelet therapy in this setting because it associated with worse prognosis.

References

  1. 1.↵
    1. Almekhlafi MA,
    2. Goyal M
    . Antiplatelet therapy prior to temporary stent-assisted coiling. AJNR Am J Neuroradiol 2014;35:E6 doi:10.3174/ajnr.A4090 pmid:25104293
    FREE Full Text
  2. 2.↵
    1. Signorelli F,
    2. Gory B,
    3. Turjman F
    . Temporary Solitaire stent-assisted coiling: a technique for the treatment of acutely ruptured wide-neck intracranial aneurysms. AJNR Am J Neuroradiol 2014;35:984–88 doi:10.3174/ajnr.A3798 pmid:24335544
    Abstract/FREE Full Text
  3. 3.↵
    1. Bodily KD,
    2. Cloft HJ,
    3. Lanzino G, et al
    . Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 2011;32:1232–36 doi:10.3174/ajnr.A2478 pmid:21546464
    Abstract/FREE Full Text
  4. 4.↵
    1. Bechan RS,
    2. Sprengers ME,
    3. Majoie CB, et al
    . Stent-assisted coil embolization of intracranial aneurysms: complications in acutely ruptured versus unruptured aneurysms. AJNR Am J Neuroradiol 2015 Sep 24. [Epub ahead of print] doi:10.3174/ajnr.A4542 pmid:26405089
    CrossRefPubMed
  5. 5.↵
    1. Kung DK,
    2. Policeni BA,
    3. Capuano AW, et al
    . Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg 2011;114:1021–27 doi:10.3171/2010.9.JNS10445 pmid:20950080
    CrossRefPubMed
  6. 6.↵
    1. Yang P,
    2. Zhao K,
    3. Zhou Y, et al
    . Stent-assisted coil placement for the treatment of 211 acutely ruptured wide-necked intracranial aneurysms: a single-center 11-year experience. Radiology 2015;276:545–52 doi:10.1148/radiol.2015140974 pmid:25822469
    CrossRefPubMed
  • © 2016 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 37 (3)
American Journal of Neuroradiology
Vol. 37, Issue 3
1 Mar 2016
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In Reply to Antiplatelet Therapy Prior to Temporary Stent-Assisted Coiling
B. Gory, F. Signorelli, F. Turjman
American Journal of Neuroradiology Mar 2016, 37 (3) E30; DOI: 10.3174/ajnr.A4661

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In Reply to Antiplatelet Therapy Prior to Temporary Stent-Assisted Coiling
B. Gory, F. Signorelli, F. Turjman
American Journal of Neuroradiology Mar 2016, 37 (3) E30; DOI: 10.3174/ajnr.A4661
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