Document resource
Introduction/Purpose Thromboembolic events are a known complication of the endovascular treatment of intracranial aneurysms. Postoperative MRI with diffusion-weighted imaging (DWI) can be used to detect these events. Rates of DWI-positive lesions (‘hits’) following treatment have been reported as high as 92.1% (range 40%-92.1%), depending on the treatment modality used. We present the rates of DWI hits and new neurologic deficits following elective aneurysm treatment.Materials and Methods A retrospective review was performed of consecutive adult patients who underwent elective embolization of unruptured intracranial aneurysms from January 2019 to December 2024. Medical records were reviewed for patient demographics, procedural details, periprocedural medication management, postoperative MRI findings, and neurologic outcomes. Patients were identified who had evidence of DWI hits on MRI. Additionally, the incidence of new postoperative neurologic deficits was collected.Results 399 adult patients underwent elective treatment of unruptured aneurysms over the identified 5-year period. Patients were 73.7% female (n=294) and 26.3% male (n=105) with an average age of 57.3 years. Patients were treated with a variety of endovascular techniques, including flow-diverter embolization and stent-assisted coil embolization most commonly (41.9% and 35.3%, respectively). 386 patients were on dual-antiplatelet therapy preoperatively (96.7%), 12 patients were on aspirin monotherapy (3%), and 1 patient was on no antiplatelet agent. Across all treatment modalities, 136 patients (34.1%) had DWI hits on postoperative MRI. 18 patients (4.5%) developed new neurologic deficits, the majority of which were mild/transient. There was no correlation between the presence of DWI hits and the development of new neurologic deficits postoperatively (p=0.40). On univariate and multivariate analysis, older age, longer procedure times, and use of an occlusive balloon were associated with the presence of DWI hits on MRI.Conclusion We report a large series of patients who underwent elective embolization of unruptured intracranial aneurysms with a lower-than-average rate of thromboembolic events on MRI. Further investigation is warranted to determine (1) the reasons behind this finding, although it is hypothesized that consistent periprocedural use of antiplatelet agents and the use of the transfemoral route are at least partially responsible, and (2) what interventions can minimize the risks of thromboembolic events going forward.Disclosures K. Bowman: None. J. McGrath: None. I. Tan: None. K. Capel: None. E. Nico: None. A. Elbayomy: None. D. Niemann: None. B. Aagaard-Kienitz: None.Abstract E-014 Table 1Predictors of DWI+Variablep-valueAge<0.001Vessel Treated0.177Anterior vs. Posterior Circulation0.994Previously Ruptured0.463Access Route0.364Total Procedure Time0.004Abstract E-014 Table 2Medication predictors of DWI+Variablep-valueAnti-Platelet Agent0.262Post Op Heparin Infusion0.949Pre Op ARU0.93Pre Op PRU0.53Post Op PRU0.84Average Intra Op ACT0.23Abstract E-014 Table 3Surgical predictors of DWI+Procedure TypeaOR95% CIp-valuePrimary CoilingReferenceFlow Diverter1.020.62-2.370.59Stent-Assisted Coiling0.820.42-1.620.56Intra-Saccular1.150.38-3.350.80Stent Only1.820.26-12.940.53Flow Diverter + Coils0.400.04-2.120.30Balloon-Assisted Coiling31.491.41-7.030.030