Treatment of the acute thromboembolic event during endovascular embolization of intracranial aneurysm

Bing Zhou; Yang He; Jun Cheng; XiaoDong Lu; MingZhao Zhang; Bo Li; RongQing Qin; ZhongMing Gao

doi:10.1016/j.jimed.2020.08.002

Treatment of the acute thromboembolic event during endovascular embolization of intracranial aneurysm

J Interv Med. 2020 Aug 18;3(4):208-212. doi: 10.1016/j.jimed.2020.08.002. eCollection 2020 Dec.

Authors

Bing Zhou¹, Yang He¹, Jun Cheng², XiaoDong Lu³, MingZhao Zhang¹, Bo Li¹, RongQing Qin¹, ZhongMing Gao³

Affiliations

¹ Department of Interventional Neuroradiology, Hangzhou Normal University Hospital, Hangzhou City, Zhejiang Province, China.
² Department of Neurosurgery, Hangzhou Normal University Hospital, Hangzhou City, Zhejiang Province, China.
³ Department of Neurology, Hangzhou Normal University Hospital, Hangzhou City, Zhejiang Province, China.

Abstract

Objective: The study aimed to discuss the treatment of acute thromboembolic event (TE) during endovascular embolization of intracranial aneurysms.

Methods: Between April 2013 and April 2019, 158 patients with 167 intracranial aneurysms were treated with endovascular embolization in our hospital, in which 9 cases of acute TEs occurred during the embolization procedures. The clinical data, radiological findings and treatments of the 9 patients were reviewed and analyzed.

Results: The TEs occurred at the aneurysmal neck in 3 patients, at distal part of the parent artery in 3, in the stent in 2, and at the proximal part of the parent artery in 1. Intra-arterial (IA) infusion of tirofiban were performed in 6 patients, mechanical thromboectomy (MT) with a stent in 2 patients, and combined use of the two methods in 1 patients. According to the modified Thrombolysis In Cerebral Infarction (mTICI) score, 7 patients had recanalization of 2b/3a, 1 patients had recanalization of 1, and 1 patients had recanalization of 0. At discharge, the mRS score was 0 in 3 patients, 1 in 3 patients, and 2, 3, 4 in 1 patient each. 6 months after the endovascular treatment, the mRS score was 0 in 5 patients, 1 in 2 patients, and 3 in 1 patient.

Conclusions: IA tirofiban and MT are effective remedies for the acute TE during endovascular embolization of intracranial aneurysm, reasonable selection of which may improve the prognosis of patients.

Keywords: Aneurysm; Embolization; Intra-arterial, IA; Mechanical thromboectomy, MT; Thromboembolic event, TE.