Risk Factor Analysis of Delayed Intracerebral Hemorrhage After Coil Embolization of Unruptured Cerebral Aneurysms

Abstract

Background: We sought to analyze diffusion-weighted imaging (DWI) and dual antiplatelet therapy (DAPT) for risk factors of delayed intracerebral hemorrhage (d-ICH) after coil embolization for an unruptured intracranial aneurysm (UIA). Methods: A total of 539 aneurysms were analyzed in this study. Ruptured and flow diverter cases were excluded. All aneurysms enrolled in this study were treated with stent-assisted or simple coiling techniques. Before the procedure, all patients administered (DAPT). After the procedure, patients who underwent stent-assisted coil embolization were given DAPT, and patients who underwent simple coiling were given single antiplatelet therapy (SAPT) only during their admission. The response of the antiplatelet agent was assessed the day before the procedure with The VerifyNow assay. DWI MRI and CT were obtained routinely the next day after the procedure. d-ICH was defined as an intracerebral hemorrhagic lesion identified in follow up CT at least 48 h after the procedure. Results: A larger positive lesion on day 1 DWI MRI (p = 0.001), the value of PRU (p = 0.002), and the inhibition rate (p = 0.025) were considered meaningful risk factors for d-ICH in univariate analysis. Accordingly, larger DWI positivity (OR = 83.73, 95% CI = 11.132-712.886, P = 0.001) and PRU (OR = 0.98, 95% CI = 0.972-0.999, P = 0.033) reached statistical significance in multivariate analysis. Conclusions: Thromboembolic infarction may work as an initiating factor, and antiplatelet medication may work as an aggravating factor. We might suggest that a tailored reduction in antiplatelet agents could help reduce d-ICH when a larger volume of post-procedural thromboembolic infarction is seen on 1-day follow-up DWI MRI.

Keywords: antiplatelate activity; cerebral hemorrhage; embolization; intracranial aneurysm; risk factor.

Figure 1

Eight cases of d-ICH: (A) pre-procedural angiograms, (B) post-procedural angiograms, with treated aneurysm indicated (arrow), (C) one-day post-procedural follow-up DWI, (D) follow-up CT scan, d-ICH identified.