Abstract 172: Outcomes and Complications of Stent‐Assisted Aneurysm Repair in Acute Subarachnoid Hemorrhage

Abstract

Introduction The use of detachable coils for endovascular embolization of cerebral aneurysms has become a safe and effective alternative to direct surgical clipping in patients with ruptured aneurysmal subarachnoid hemorrhage. However, endovascular treatment of wide‐necked, large (>10 mm), and complex ruptured aneurysms continues to remain challenging despite multiple technical advancements in recent years. In order to improve treatment outcomes in these difficult cases, the use of stent‐assisted embolization has been attempted in endovascular treatment of intracranial aneurysms. In order to avoid thromboembolic complications in these cases, patients require treatment with antiplatelet therapy. Previous studies have shown that antiplatelet therapy poses an increased risk of hemorrhagic complications; this risk might be further heightened in the setting of acute subarachnoid hemorrhage (SAH), as these patients can develop an abnormal coagulation status. The purpose of this study was to retrospectively analyze the results and complications associated with stent‐assisted embolization of intracranial aneurysms in the acute treatment of subarachnoid hemorrhage at Dell Seton Medical Center. Methods Data from patients with acutely‐ruptured intracranial aneurysm treated with stent‐assisted embolization at Dell Seton Medical Center in the period between 2021 and 2022 were retrospectively assessed, with the focus of addressing aneurysm occlusion, clinical outcomes and complications. Results Fifteen patients with ruptured intracranial aneurysms were included in the analysis. Post‐procedural re‐rupture and hemorrhagic complications were observed in three patients, leading to death in two patients. Thromboembolic complications were observed in one patient, with the clinical outcome of death due to basilar stent thrombosis. Immediate complete occlusion and occlusion with residual neck was achieved in 66.7% of cases. Conclusion In the case of ruptured intracranial aneurysms with large and complex morphology and a wide neck, the use of stent‐assisted repair may be necessary compared to simpler and smaller aneurysms that can be treated with coils alone. The use of stent‐assisted repair in acutely‐ruptured aneurysms in this series of cases demonstrated rapid and good aneurysmal occlusion. The post‐procedural complication rate proved to be higher than in non‐ruptured stent‐assisted coiling. However, the overall resulting morbidity and mortality rates in this cohort of patients is lower than could have been expected; furthermore, the complication rates found in this study are in line with those reported in similar studies. In most cases in the emergency setting, it is not possible to appropriately prepare a patient with antiplatelet therapy pre‐procedurally. As a result, the proper antiplatelet medication regimen and its appropriate timing continue to remain a significant topic of investigation. In addition, there continues to be further investigation into the optimal timing of intervention to minimize risk of peri‐procedural and post‐procedural complications. Further retrospective analysis of patient data over multiple years and across multiple centers is needed to better assess outcomes and complications of stent‐assisted aneurysm repair in acute subarachnoid hemorrhage.