Login Register Cart 0
Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Microbleeds after Stent-assisted Coil Embolization of Unruptured Intracranial Aneurysms: Incidence, Risk Factors and the Role of Thromboelastography

Author(s): Rui Xu, Chongjie Cheng, Yue Wu, Zongduo Guo, Xiaochuan Sun, Yongzhi Xia* and Xiaodong Zhang*

Volume 17, Issue 4, 2020

Page: [502 - 509] Pages: 8

DOI: 10.2174/1567202617999200819161033

Price: $65

Abstract

Objective: To analyze the incidence and risk factors of microbleeds lesions and to use thromboelastography (TEG) to evaluate the relationship between perioperative platelet function and microbleed events in patients with unruptured intracranial aneurysms (UIAs) undergoing Stent-Assisted Coil (SAC) embolization.

Methods: We retrospectively enrolled 261 patients with UIAs undergoing SAC embolization between November 2017 and October 2019. All patients received unanimous antiplatelet protocol (aspirin 300 mg and clopidogrel 300 mg). Platelet function was evaluated by TEG, and magnetic resonance susceptibility-weighted imaging (SWI) was performed for microbleeds detection before and after surgery. Univariate and multivariate logistic regression analyses were used to identify potential risk factors for microbleeds following embolization.

Results: Microbleed lesions were identified in 122 of 261 patients (46.7%). Most of the microbleeds were asymptomatic, except for 22 patients complaining slight headaches, and 3 patients who developed cerebral hemorrhage after discharge. Among the clinical characters, female, previous intracerebral hemorrhage (ICH) history and TEG parameters variation (higher reaction time (R) and lower maximum amplitude of adenosine diphosphate (MAADP)) were associated with microbleeds occurrence. Subsequent multivariate analysis indicated that gender, hemorrhage history, R, and MAADP were still independent risk factors of microbleeds. The R-value (>7.6 min) and MAADP (<29.2 mm) were predictive values, yielding areas under the receiver operating curve (ROC) of 0.76 (95% CI 0.70 to 0.82) and 0.89 (95% CI 0.86 to 0.93), respectively.

Conclusion: The incidence of microbleeds may be high in UIA patients treated with SAC and dual antiplatelet therapy. Lesions occurred more frequently in female patients and patients with ICH history. Among the TEG parameters, the R-value and MAADP were predictors for microbleed events.

Keywords: Microbleeds, stent-assisted coil, unruptured intracranial aneurysms, thromboelastography, Cerebral infarction, antiplatelet drugs.

« Previous Next »
[1]
Shimamura N, Naraoka M, Matsuda N, et al. Use of preprocedural, multiple antiplatelet medications for coil embolization of ruptured cerebral aneurysm in the acute stage improved clinical outcome and reduced thromboembolic complications without hemorrhagic complications. World Neurosurg 2020; 133: e751-6.
[http://dx.doi.org/10.1016/j.wneu.2019.09.149] [PMID: 31604135]
[2]
Dornbos D III, Katz JS, Youssef P, Powers CJ, Nimjee SM. Glycoprotein IIb/IIIa inhibitors in prevention and rescue treatment of thromboembolic complications during endovascular embolization of intracranial aneurysms. Neurosurgery 2018; 82(3): 268-77.
[http://dx.doi.org/10.1093/neuros/nyx170] [PMID: 28472526]
[3]
Kim DJ, Suh SH, Kim BM, Kim DI, Huh SK, Lee JW. Hemorrhagic complications related to the stent-remodeled coil embolization of intracranial aneurysms. Neurosurgery 2010; 67(1): 73-8.
[http://dx.doi.org/10.1227/01.NEU.0000370937.70207.95] [PMID: 20559093]
[4]
King B, Vaziri S, Singla A, Fargen KM, Mocco J. Clinical and angiographic outcomes after stent-assisted coiling of cerebral aneurysms with Enterprise and Neuroform stents: A comparative analysis of the literature. J Neurointerv Surg 2015; 7(12): 905-9.
[http://dx.doi.org/10.1136/neurintsurg-2014-011457] [PMID: 25352581]
[5]
Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK. Stent-supported aneurysm coiling: A literature survey of treatment and follow-up. AJNR Am J Neuroradiol 2012; 33(1): 159-63.
[http://dx.doi.org/10.3174/ajnr.A2719] [PMID: 22033717]
[6]
Kim BJ, Lee SH. Cerebral microbleeds: their associated factors, radiologic findings, and clinical implications. J Stroke 2013; 15(3): 153-63.
[http://dx.doi.org/10.5853/jos.2013.15.3.153] [PMID: 24396809]
[7]
Werring DJ, Frazer DW, Coward LJ, et al. Cognitive dysfunction in patients with cerebral microbleeds on T2*-weighted gradient-echo MRI. Brain 2004; 127(Pt 10): 2265-75.
[http://dx.doi.org/10.1093/brain/awh253] [PMID: 15282216]
[8]
Haller S, Scheffler M, Salomir R, et al. MRI detection of cerebral microbleeds: Size matters. Neuroradiology 2019; 61(10): 1209-13.
[http://dx.doi.org/10.1007/s00234-019-02267-0] [PMID: 31396662]
[9]
Wong KS, Chan YL, Liu JY, Gao S, Lam WW. Asymptomatic microbleeds as a risk factor for aspirin-associated intracerebral hemorrhages. Neurology 2003; 60(3): 511-3.
[http://dx.doi.org/10.1212/01.WNL.0000046583.40125.20] [PMID: 12578941]
[10]
Qiu J, Ye H, Wang J, Yan J, Wang J, Wang Y. Antiplatelet therapy, cerebral microbleeds, and intracerebral hemorrhage: A Meta- Analysis. Stroke 2018; 49(7): 1751-4.
[http://dx.doi.org/10.1161/STROKEAHA.118.021789] [PMID: 29798835]
[11]
Sakuta K, Yaguchi H, Sato T, et al. The impact of cerebral microbleeds presence on outcome following minor stroke treated with antiplatelet therapy. Front Neurol 2020; 11: 522.
[http://dx.doi.org/10.3389/fneur.2020.00522] [PMID: 32612570]
[12]
Kawano-Castillo J, Ward E, Elliott A, et al. Thrombelastography detects possible coagulation disturbance in patients with intracerebral hemorrhage with hematoma enlargement. Stroke 2014; 45(3): 683-8.
[http://dx.doi.org/10.1161/STROKEAHA.113.003826] [PMID: 24425123]
[13]
Wang X, Dang A, Lv N, Cheng N, Cheng X. Inflammation is associated with platelet coagulation function rather than enzymatic coagulation function in patients with takayasu arteritis. Int Heart J 2017; 58(4): 589-92.
[http://dx.doi.org/10.1536/ihj.16-533] [PMID: 28701681]
[14]
Roob G, Schmidt R, Kapeller P, Lechner A, Hartung HP, Fazekas F. MRI evidence of past cerebral microbleeds in a healthy elderly population. Neurology 1999; 52(5): 991-4.
[http://dx.doi.org/10.1212/WNL.52.5.991] [PMID: 10102418]
[15]
Tsushima Y, Tanizaki Y, Aoki J, Endo K. MR detection of microhemorrhages in neurologically healthy adults. Neuroradiology 2002; 44(1): 31-6.
[http://dx.doi.org/10.1007/s002340100649] [PMID: 11942497]
[16]
Igase M, Tabara Y, Igase K, et al. Asymptomatic cerebral microbleeds seen in healthy subjects have a strong association with asymptomatic lacunar infarction. Circ J 2009; 73(3): 530-3.
[http://dx.doi.org/10.1253/circj.CJ-08-0764] [PMID: 19151503]
[17]
Poels MMF, Vernooij MW, Ikram MA, et al. Prevalence and risk factors of cerebral microbleeds: An update of the Rotterdam scan study. Stroke 2010; 41(10)(Suppl.): S103-6.
[http://dx.doi.org/10.1161/STROKEAHA.110.595181] [PMID: 20876479]
[18]
Vernooij MW, van der Lugt A, Ikram MA, et al. Prevalence and risk factors of cerebral microbleeds: The Rotterdam Scan Study. Neurology 2008; 70(14): 1208-14.
[http://dx.doi.org/10.1212/01.wnl.0000307750.41970.d9] [PMID: 18378884]
[19]
Staals J, van Oostenbrugge RJ, Knottnerus IL, Rouhl RP, Henskens LH, Lodder J. Brain microbleeds relate to higher ambulatory blood pressure levels in first-ever lacunar stroke patients. Stroke 2009; 40(10): 3264-8.
[http://dx.doi.org/10.1161/STROKEAHA.109.558049] [PMID: 19661468]
[20]
Kim BJ, Lee SH, Kang BS, Yoon BW, Roh JK. Diabetes increases large artery diseases, but not small artery diseases in the brain. J Neurol 2008; 255(8): 1176-81.
[http://dx.doi.org/10.1007/s00415-008-0864-0] [PMID: 18537055]
[21]
Naka H, Nomura E, Wakabayashi S, et al. Frequency of asymptomatic microbleeds on T2*-weighted MR images of patients with recurrent stroke: Association with combination of stroke subtypes and leukoaraiosis. AJNR Am J Neuroradiol 2004; 25(5): 714-9.
[PMID: 15140709]
[22]
Ovbiagele B, Liebeskind DS, Pineda S, Saver JL. Strong independent correlation of proteinuria with cerebral microbleeds in patients with stroke and transient ischemic attack. Arch Neurol 2010; 67(1): 45-50.
[http://dx.doi.org/10.1001/archneurol.2009.310] [PMID: 20065128]
[23]
Ryu WS, Lee S-H, Kim CK, Kim BJ, Yoon BW. The relation between chronic kidney disease and cerebral microbleeds: Difference between patients with and without diabetes. Int J Stroke 2012; 7(7): 551-7.
[http://dx.doi.org/10.1111/j.1747-4949.2011.00732.x] [PMID: 22243603]
[24]
Jeon SB, Kang DW, Cho AH, et al. Initial microbleeds at MR imaging can predict recurrent intracerebral hemorrhage. J Neurol 2007; 254(4): 508-12.
[http://dx.doi.org/10.1007/s00415-006-0406-6] [PMID: 17401517]
[25]
Yakushiji Y, Wilson D, Ambler G, et al. Distribution of cerebral microbleeds in the East and West: Individual participant meta-analysis. Neurology 2019; 92(10): e1086-97.
[http://dx.doi.org/10.1212/WNL.0000000000007039] [PMID: 30709966]
[26]
Fisher M, French S, Ji P, Kim RC. Cerebral microbleeds in the elderly: A pathological analysis. Stroke 2010; 41(12): 2782-5.
[http://dx.doi.org/10.1161/STROKEAHA.110.593657] [PMID: 21030702]
[27]
Charidimou A, Kakar P, Fox Z, Werring DJ. Cerebral microbleeds and recurrent stroke risk: Systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts. Stroke 2013; 44(4): 995-1001.
[http://dx.doi.org/10.1161/STROKEAHA.111.000038] [PMID: 23493732]
[28]
Charidimou A, Imaizumi T, Moulin S, et al. Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: A meta-analysis. Neurology 2017; 89(8): 820-9.
[http://dx.doi.org/10.1212/WNL.0000000000004259] [PMID: 28747441]
[29]
Rivard GE, Brummel-Ziedins KE, Mann KG, Fan L, Hofer A, Cohen E. Evaluation of the profile of thrombin generation during the process of whole blood clotting as assessed by thrombelastography. J Thromb Haemost 2005; 3(9): 2039-43.
[http://dx.doi.org/10.1111/j.1538-7836.2005.01513.x] [PMID: 16102110]
[30]
Yang H, Li Y, Jiang Y, Lv X. Thromboelastography for monitoring platelet function in unruptured intracranial aneurysm patients undergoing stent placement. Interv Neuroradiol 2015; 21(1): 61-8.
[http://dx.doi.org/10.15274/INR-2014-10094] [PMID: 25934777]
[31]
Blais N, Pharand C, Lordkipanidzé M, Sia YK, Merhi Y, Diodati JG. Response to aspirin in healthy individuals. Cross-comparison of light transmission aggregometry, VerifyNow system, platelet count drop, thromboelastography (TEG) and urinary 11-dehydrothromboxane B(2). Thromb Haemost 2009; 102(2): 404-11.
[PMID: 19652893]
[32]
Madsen EH, Saw J, Kristensen SR, Schmidt EB, Pittendreigh C, Maurer-Spurej E. Long-term aspirin and clopidogrel response evaluated by light transmission aggregometry, VerifyNow, and thrombelastography in patients undergoing percutaneous coronary intervention. Clin Chem 2010; 56(5): 839-47.
[http://dx.doi.org/10.1373/clinchem.2009.137471] [PMID: 20224050]
[33]
Gurbel PA, Bliden KP, Navickas IA, et al. Adenosine diphosphate-induced platelet-fibrin clot strength: A new thrombelastographic indicator of long-term poststenting ischemic events. Am Heart J 2010; 160(2): 346-54.
[http://dx.doi.org/10.1016/j.ahj.2010.05.034] [PMID: 20691842]
[34]
Tantry US, Bonello L, Aradi D, et al. Working Group on On-Treatment Platelet Reactivity. Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol 2013; 62(24): 2261-73.
[http://dx.doi.org/10.1016/j.jacc.2013.07.101] [PMID: 24076493]
[35]
Nakae R, Nagaishi M, Kawamura Y, Tanaka Y, Hyodo A, Suzuki K. Microhemorrhagic transformation of ischemic lesions on T2*-weighted magnetic resonance imaging after Pipeline embolization device treatment. J Neurosurg 2018; 1: 1-8.
[PMID: 29999443]

Rights & Permissions Print Cite
Article Metrics
33
© 2024 Bentham Science Publishers | Privacy Policy