Stent assisted coiling of the ruptured wide necked intracranial aneurysm.

BACKGROUND

Stent assisted coiling of unruptured wide necked intracranial aneurysms require antiplatelets to prevent stent thrombosis. The effect of the loading dose of antiplatelets prior to the stent coiling procedure in an unsecured wide necked ruptured intracranial aneurysm is not known.

OBJECTIVE

To report any potential complication associated with the use of both aspirin and clopidogrel in stent assisted coiling of ruptured wide necked intracranial aneurysms.

METHODS

Consecutive patients who underwent stent assisted coiling for ruptured wide necked intracranial aneurysm were enrolled from 2005 to 2009. Patients' demographics, including Hunt and Hess grade, Fisher scale, and location and size of aneurysms, were collected. Complications such as rupture of aneurysm, thromboembolic events, ventriculostomy associated or systemic hemorrhages were recorded. Additionally, a 90 day outcome measurement was obtained using the Glasgow Outcome Scale.

RESULTS

22 patients with a mean age of 50±13 years underwent stent assisted coiling. A loading dose of clopidogrel 300 mg and aspirin 325 mg orally were given prior to stent placement. There was no intraoperative rupture of aneurysm, ventriculostomy associated hemorrhage or systemic hemorrhagic event. There were two episodes of stent thrombosis; one was an asymptomatic event which developed during the stent assisted coiling procedure and resolved spontaneously; the other was symptomatic which required intra-arterial administration of glycoprotein IIbIIIa receptor antagonist. There was no mortality and good outcome was observed in 82% of patients.

CONCLUSION

In our series of carefully selected patients, therapeutic dual antiplatelet loading prior to stent assisted coiling of ruptured wide necked intracranial aneurysm was not associated with increased bleeding complications. However, thromboembolic events remain the main challenge. Further study is required to confirm the safety of antiplatelet loading in stent assisted ruptured intracranial aneurysm coiling.