Abstract
Background: There is still controversy regarding which procedure-related factors affect the occurrence of periprocedural thromboembolism. This study aimed to investigate which procedure-related risk factors can be modified to prevent adverse thromboembolic events after coil embolization of intracranial aneurysm.Methods: Using a single-center database, we retrospectively identified a consecutive series of patients with symptomatic and asymptomatic cerebral aneurysms treated with coil embolization. We evaluated the following procedure-related factors: procedure time, procedure methods (simple coiling, stent-assisted coiling, and use of multiple microcatheters), and number of coils inserted. The primary outcome was the development of thromboembolism before and after coil embolization confirmed by diffusion-weighted imaging (DWI) irrespective of the location of the procedure. Pearson's chi-square, Student's t-test, multivariable logistic regression analysis, and sensitivity analysis with multinomial logistic regression analysis were used in the statistical analyses.Results: Of 180 cases enrolled, 146 (81.1%) had evidences of thromboembolism confirmed by DWI, and 13 (7.2%) had neurologic symptoms. Among the documented modifiable procedure-related factors, every 10 min increase in the procedure time was independently associated with the risk of thromboembolism, after adjusting the analysis (adjusted odds ratio 1.11; 95% confidence interval 1.01–1.21). The coiling methods, use of multiple catheters, and number of coils inserted did not change the effect of the procedure time on thromboembolic events (p for interactions > 0.05).Conclusion: This study showed that the procedure time might be the most effective modifiable factor for reducing thromboembolic events irrespective of the procedure methods used during coil embolization of cerebral aneurysms.
Highlights
The incidence of periprocedural thromboembolism is reported as 10–69%, and it is the most frequent complication of coil embolization for cerebral aneurysm [1,2,3,4,5,6,7,8,9,10,11]
The overall rate of thromboembolism confirmed by DWI after coil embolization was 81.1% (n = 146)
Considering above mentioned, this study had main findings as follows; [1] we found that among the modifiable procedure-related factors, reducing the procedure time could be effective for reducing the risk of thromboembolism after coil embolization; [2] we suggested that practical efforts, such as reducing procedure manipulations and establishing efficient procedure process, should be performed by the interventionist to reduce the procedure time in real-world practice
Summary
The incidence of periprocedural thromboembolism is reported as 10–69%, and it is the most frequent complication of coil embolization for cerebral aneurysm [1,2,3,4,5,6,7,8,9,10,11]. Age and aneurysmal size are non-modifiable factors so they would be helpful only to distinguish the patients at high risk of periprocedural thromboembolism. There is still controversy regarding the procedure-related factors, the procedure technique itself is considered to have a high possibility of affecting the occurrence of periprocedural thromboembolism. One explanation for this is that prior studies assessed the procedure technique, which was mostly a newly introduced coil device or technique, so it was difficult to evaluate the effects of various risk factors. This study aimed to investigate which procedure-related risk factors can be modified to prevent adverse thromboembolic events after coil embolization of intracranial aneurysm
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