Coiling Techniques in management of Cerebral Aneurysms Preoperative assessment, Outcome and Complications

Hassan, Enas M.; Elbassiony, Ahmed A. Ibrahim; Ismail, Mohamed M.; Khafagy, Ahmed Z.

doi:10.21608/mjmr.2022.221923

Coiling Techniques in management of Cerebral Aneurysms Preoperative assessment, Outcome and Complications

Document Type : Original Article

Authors

¹ Department of Neurology- Faculty of Medicine- Minya University1

² Department of Neurology - Faculty of Medicine- Ain Shams university

³ * Department of Neurology- Faculty of Medicine- Minya University

10.21608/mjmr.2022.221923

Abstract

Background: according to the International Subarachnoid Trial (ISAT), patients with subarachnoid
hemorrhage (SAH) fared better with endovascular coiling than those with surgical clipping
(Molyneux et al., 2005). With the emergence of flow diversion as a useful technique in management
of cerebral aneurysm, endovascular techniques now have many varieties that enable the
interventionalist to achieve best outcome. Objective: This study aimed to compare the outcome and
complications between balloon assisted coiling and the use of Flow diverter stent, also studying the
theoretical effect of antiplatelet use in flow diverter group and whether there is an added risk for
development of bleeding. Patients and Methods: Thirty two patients were included in this study
between February/2016 and June/2017. Age range was 25-69 (54± 10.5) for balloon group (Group B =17),
30-68 years old (50.7±10.1) for the Flow diverter group (Group F=15). The females were 10 (58%) in the
balloon group and 6 (40%) in the Flow diverter group. No statistically significant difference was found
between two groups. Those patient were found to have wide neck aneurysm by either CT cerebral
angiography of 4 vessel angiography. Patient undergo preoperative assessment using NIHS stroke scale,
modified Rankin scale, Hunt and Hess scale and modified fisher scale. Post-operative assessment included,
modified Rankin scale for clinical outcome and Raymond Roy scale for the degree of obliteration of
aneurysm. Follow up study was done after 6 month of the procedure including the same sale to detect the
clinical improvement as well as recanalization rate. Results: Regarding follow up assessment in clinical
outcome, significant improvement occurred in both groups with minimal or no symptoms in 15 out of
17 (88.23%) in the balloon group and 14 out of 15 (93%) in the flow diverter group. Findings show
that total obliteration was achieved immediately in most of cases (11 out of 17 in the balloon group,
13 out of 15 in the Flow diverter group). No significant difference between angiographic outcome of
immediate and follow up imaging in the case of flow diverter. There is a significant difference
between the immediate and follow up score of the balloon group but eventually most of the cases
achieve complete obliteration (15 out of 17). Regarding complications, the operation went uneventful
for more than 2 thirds of cases in each group. Although thrombotic complication is higher in Flow
diverter group (20% for FD Vs 11.8% for B), manifest infarction is paradoxically higher in Balloon
group (6.7% for FD Vs 17.6% for B). Hemorrhagic event occurred only once in balloon group (5.9%).
For correlation, clinical outcome correlates with radiological outcome (P=0.007 significant level is
P<0.001). Conclusion: both techniques are safe and effective in management of wide neck cerebral
aneurysm with no significant difference between both techniques. Selection of either method is upon
the experience of the interventional neurologist’s experience and preference.

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