gms | German Medical Science

Objective: Endovascular embolization of unruptured, asymptomatic aneurysms using platinum coils has gained increasing acceptance as an alternative to surgery. Our purpose was to determine the incidence of ischemic events after coiling using diffusion weighted imaging (DWI) correlated with neurological findings.

Methods: In a retrospective study 135 patients were analyzed over a 2.5-year-period. MRI including diffusion-weighted imaging was performed within 72 hours after elective aneurysm treatment. Embolization was performed under systemic heparinisation and the use of intravenous aspirin during and after the treatment. The pre-procedure workup included digital subtraction angiography and MR imaging. After the procedure, all treated patients were examined by a neurosurgeon or a neurologist. MRI examinations were reviewed by two neuroradiologists. The DWI lesions were classified in 4 groups according to their diameter: 1=1-5mm, 2=6-10mm, 3=11-15 and 4=16-20. Lesions larger than 20mm were classified as partial ischemic strokes.

Results: Diffusion-weighted MRI showed bright lesions in 62 (45%) patients. All lesions except 10 (7.4%) were located ipsilateral to the side of the catheterisation, the most common sites were the territory of the middle and the anterior cerebral artery. 14 (21%) patients developed transient neurological symptoms, 3 of them (2.2%) had persistent neurological deficits. Overall rate of asymptomatic ischemic lesions was 34% (46 of 135 treatments). Thrombembolic lesions appeared to depend on the patient’s age and the thrombus formation during the treatment (p<0,1). Aneurysmal rupture occurred in one case, the patient had no neurological deficits except headache after the treatment.

Conclusions: Silent ischemic events during endovascular treatment are more common despite systemic anticoagulation and antiplatetet therapy. The incidence of symptomatic ischemic infarction (2.2%) is closely related to the patient's age.