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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Microembolic signal monitoring after coiling of unruptured cerebral aneurysms: An observational analysis of 123 cases

Meeting Abstract

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  • G. Schubert - Neurochirurgische Klinik, Medizinische Universität Innsbruck, Österreich
  • M. Seiz-Rosenhagen - Neurochirurgische Klinik, Medizinische Universität Innsbruck, Österreich
  • C. Thomé - Neurochirurgische Klinik, Medizinische Universität Innsbruck, Österreich
  • J. Eskridge - Neurointerventional Radiology, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, USA

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 009

doi: 10.3205/11dgnc230, urn:nbn:de:0183-11dgnc2307

Published: April 28, 2011

© 2011 Schubert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Thromboembolic events after aneurysm coiling are common, but the optimal treatment algorithm for emboli prevention remains unclear. Evidence of microembolic signals (MES) correlates with the occurrence of impending ischemic events and may be used for management guidance. This study aims to define the role of MES monitoring with regard to aneurysm characteristics, coiling technique and anticoagulation protocol.

Methods: We analyzed 123 consecutive, elective endovascular procedures. All patients received intraprocedural heparin, and continuous heparinization for 12hrs if possible. Demographic data, size of the aneurysm, type of intervention/complication, medication, imaging and clinical outcome were obtained and analyzed. MES monitoring was performed in all patients both early (immediately after) as well as late (greater than 12hrs after the procedure).

Results: Heparinization within the first 12hrs significantly decreased the number of MES early after coiling (3.4 vs 18.8 MES/hr, p<0.05). When on heparin, larger aneurysm size, stent-assisted procedures or incomplete occlusion were not associated with a significant increase in MES. If the initial MES count on heparin was less than 10MES/hr, it was always save to discontinue heparin. Inability to initiate early, continuous heparinization was significantly associated with new neurological deficits (p<0.05). Additional administration of antiplatelet agents was associated with a lower MES count initially, but the difference was not significant.

Conclusions: MES monitoring is a powerful adjunct to monitor efficacy of treatment algorithms aimed at the prevention of embolic complications after coiling. In our series, only early heparinization effectively lowered the incidence of MES. This is of particular importance in larger aneurysms, stent-assisted procedures and incomplete occlusions, where the thromboembolic risk is greatest early on and antiplatelet treatment alone may not suffice.