Ahead of Print: Cognition After Coiling Intracranial Aneurysm

Background: Thromboembolic events are the most common complication following coiling of unruptured intracranial aneurysms (UIA). However, it remains unclear whether these clinically silent ischemic lesions (CSIL) have any clinical significance.

Objective: To evaluate cognitive outcome after coil embolization of asymptomatic UIA and its relationship with CSIL after the procedure.

Methods: We prospectively enrolled 40 UIA patients who showed no new focal neurological deficit after coil embolization. CSIL were assessed with diffusion-weighted imaging (DWI) within 1 day after the procedure. A battery of neuropsychological tests was performed three times: preoperatively and postoperatively at 1 and 4 weeks after coil embolization.

Ahead of Print: Tirofiban in Stent-Assisted Coil Embolization

Background: Thromboembolic complications are a major concern in stent-assisted coiling (SAC) of intracranial aneurysms that may be prevented with adequate antiplatelet therapy.

Objective: To assess the safety and efficacy of tirofiban in SAC.

Methods: Two protocols were used. In the initial protocol, tirofiban was administered intravenously as a 0.4 mcg/kg/min bolus for 30 min followed by 0.10 mcg/kg/min maintenance infusion. The revised protocol consisted of a 0.10 mcg/kg/min maintenance infusion alone.

Ahead of Print: Forced Suction Thrombectomy in the Thromboembolic Events During Coiling

Background: No definite conclusive management has been established in the treatment of thromboembolism during coil embolization of cerebral aneurysms. To date, intravenous heparin, intra-arterial fibrinolytic agent, and intravenous or intra-arterial glycoprotein IIb-IIIa inhibitors have been the mainstay of treatment. However, in practice, two major concerns may arise; first, recanalization is not always possible despite every effort of management; second, rehemorrhagic risk is increased if the event occurred during coiling of ruptured cerebral aneurysms.

Objective: We introduce a new endovascular mechanical thrombectomy technique to overcome the aforementioned concerns.

Methods: In four refractory cases involving conventional pharmaceutical treatment of thromboembolism during coiling, we practiced rescue suction thrombectomy using the reperfusion catheter of the Penumbra System.