gms | German Medical Science

Objective: Endovascular treatment of intracranial aneurysms often requires anticoagulation. The aim of the present study was to determine whether there is an elevated risk for any kind of intracranial bleeding during the initial hospitalization period after endovascular aneurysm treatment and under anticoagulation.

Methods: Patients who had been treated for a ruptured intracranial aneurysm (IA) between 2003 and 2005 either by clipping or by an endovascular approach, which was performed by the Neuroradiology Department, were evaluated. Emphasis was taken to record all intracranial bleedings after surgical or endovascular treatment as shown by CCT. In order to determine the Glasgow Outcome Score (GOS), a questionnaire was sent and patients were asked for self-reporting.

Results: There were 190 patients, 84 clipped and 106 coiled. The median age was 51 and 55 years; male/female ratio 1:1.6, and 1:2.3, respectively for the clipped and coiled group. The thirty-day mortality rate was 14%. Thus, 162 patients were followed. Finally, 84 patients (52%) were enrolled for follow-up evaluation. In the surgery group, all patients received low-dose heparin for thrombosis-prophylaxis; 4 patients received heparin in higher dosages for different reasons. No patient had aspirin until discharge. There were 3 intraventricular and 14 intraparenchymal haemorrhages recorded in addition to 4 haemorrhages into the canal of and around an external ventricular drainage (EVD) or shunt device. In the endovascular group, 91 (86%) patients received heparin and 60 (56%) aspirin. There were 13 intraventricular, 23 intraparenchymal, and 20 EVD-related bleedings. Outcome according to GOS at discharge was good (GOS 4+5) in 31 (37%) and 57 (54%) patients in the surgical and endovascular group, respectively. Both groups improved equally and GOS 4+5 was found at 69% in the surgery and at 89% in the endovascular group after a median follow-up of 43 months.

Conclusions: There was a significant higher incidence of bleedings in the endovascular group compared to the surgical group. However, these findings were not associated with clinical outcome determined by the GOS at discharge or after follow-up. A more subtle evaluation of outcome, particularly of neuropsychological functioning seems to be warranted in a prospective setting. Nevertheless, the indication for any surgical procedure in patients with anticoagulation after endovascular aneurysm treatment should be thoroughly proofed.