Elsevier

World Neurosurgery

Volume 95, November 2016, Pages 335-340
World Neurosurgery

Original Article
Incidence and Characteristics of Remote Intracerebral Hemorrhage After Endovascular Treatment of Unruptured Intracranial Aneurysms

https://doi.org/10.1016/j.wneu.2016.08.057Get rights and content

Objective

The purpose of this study was to investigate the incidence and characteristics of remote intracerebral hemorrhage (ICH) after endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs).

Methods

Between March 2007 and September 2015, 11 patients with remote ICH from a series of 2258 consecutive patients with 2597 UIAs treated via EVT were identified. Baseline demographic characteristics, medical history, radiologic imaging data, characteristics of remote ICH, and clinical outcomes were retrospectively reviewed. The characteristics of patients with remote ICH were compared with those of patients without remote ICH.

Results

All hematomas were single lesions located in the subcortical white matter as lobar-type in 9 patients (81.8%) and in the basal ganglia in 2 patients (18.2%). Events occurred mostly within 1 week and up to 3 weeks after EVT. Hematoma was located on the ipsilateral side in 8 patients (72.7%) and in the contralateral side in 3 patients (27.3%). Compared with patients without remote ICH, there were more aneurysms located on the internal carotid artery (ICA) (P = 0.041), more patients treated with stents (P < 0.001), more patients with hypertension (P = 0.026), and poorer clinical outcomes at discharge (P < 0.001) for patients with remote ICH.

Conclusions

The incidence of remote ICH after EVT of UIAs was 0.46%. This event occurred mostly in patients with stents, hypertension, and UIAs on the ICA. It presented mostly as an ipsilateral lobar-type hemorrhage within 1 week after the procedure. This complication should not be neglected because of its poor clinical outcomes.

Introduction

Remote intracerebral hemorrhage (ICH) is defined as an intracranial hemorrhage that occurs at a distant site from the treated lesion. In neurosurgical fields, remote ICH is a major complication. It has been reported after microsurgery for supratentorial lesions or spine surgery, probably because of excessive cerebrospinal fluid diversion during surgery.1, 2 It has also been reported after carotid recanalization because of hyperperfusion syndrome.3 Remote ICH is very rare and is usually unexpected.

It is even rarer in neuroendovascular fields, and because of the use of flow diverters in clinical practice to treat unruptured intracranial aneurysms (UIAs), remote ICH has been reported as a potential limitation.4, 5, 6, 7 Previous to the flow-diverter era, remote ICH after endovascular treatment (EVT) of UIAs was not well described. Because such a life-threatening complication should not be neglected, we retrospectively reviewed our series to determine the incidence and characteristics of remote ICH. Therefore, the purpose of this study was to investigate the incidence and characteristics of remote ICH after EVT of UIAs.

Section snippets

Subjects

The institutional review board of our institute approved all research protocols, and informed consent was waived. The data were gathered from 5 hospitals in which 5 neurosurgeons, all alumni of a single institution, treated patients with intracranial aneurysms using similar endovascular techniques. The prospective collected database contained a series of 2258 consecutive patients (694 patients were treated using at least 1 stent) with 2597 UIAs treated with EVT between March 2007 and September

Results

Among 2258 patients with UIAs treated via EVT, 11 (0.49%) suffered remote ICH. The clinical data of all patients with remote ICH are shown in Table 1. The mean age of the participants was 59.9 ± 8.5 years, and there were 6 women. Aneurysms were located in the ICA in 8 patients (72.7%), including 1 aneurysm on the posterior communicating artery; in the anterior cerebral artery in 2 patients (18.2%); and in the basilar bifurcation in 1 patient (9.1%). The mean aneurysm and neck sizes were

Discussion

The incidence of remote ICH was 0.46% after EVT of UIAs. Remote ICH tended to occur mostly as an ipsilateral lobar-type hemorrhage within 1 week (up to 3 weeks) after the procedure in patients with UIAs on the ICA, hypertension, and treatment using stents. In addition, those patients showed poor clinical outcomes. These characteristics of remote ICH (occurrence within 7 days, aneurysm on the ICA, lobar-type, and ipsilateral ICH) are very similar to the results of remote ICH after using flow

Conclusions

The incidence of remote ICH after EVT of UIAs was 0.46%. Remote ICH mostly occurred in patients with stents, hypertension, and UIAs on the ICA and mostly presented as an ipsilateral lobar-type hemorrhage within 1 week after the procedure. This complication should not be neglected because of its poor clinical outcomes. To overcome this complication, the pathomechanism of remote ICH should be clarified in a well-designed larger-volume study.

References (18)

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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