2005 Proceedings - ASNR

Results: Sixteen patients were treated within fifteen days of the hemorrhage. All patients were loaded with Plavix 375 mg
immediately post procedure, all patients were given Plavix 75 mg daily and most patients were also given aspirin 325 mg
daily, unless there was concern for bleeding risk, such as ventriculostomy placement. Six patients had ventriculostomies
placed prior to the procedure and none were placed post procedure. Six patients were given a GPIIbIIIa inhibitor
(tirofiban) bolus dose during the procedure because of platelet aggregates seen on the stent all without complication,
including three patients with ventriculostomies. There was one symptomatic ischemic stroke (NIHSS 4) that occurred 22
days after stent placement possibly related to the stent in a patient with a ventriculostomy who was on a single antiplatelet
agent (1/16, 6.25%). Minor bleeding complications potentially related to antiplatelet therapy included one patient with two
small asymptomatic right frontal hemorrhages after vasospasm treatment, one patient with a stable epidural hematoma at
a craniotomy site not requiring treatment, and one patient with transient hematuria (3/16, 18.75%). Major bleeding
complications included one patient with a groin pseudoaneurysm that required surgical repair (1/16, 6.25%). In the
Hunt/Hess grade 1-2 patients, there were no ischemic strokes, one minor bleeding complication (stable epidural
hematoma) (1/10, 10%) and one major bleeding complication (groin pseudoaneurysm) (1/10, 10%),. In Hunt/Hess grade
3-4 patients, there was one symptomatic ischemic stroke (1/6, 17%), two minor bleeding complications (small
asymptomatic frontal hemorrhages and hematuria) (2/6, 33%) and no major bleeding complications.
Conclusion: Our preliminary data suggests that Neuroform stent-assisted coiling with the use of double antiplatelet
agents in Hunt/Hess grade 1-2 patients can be safe. Higher Hunt/Hess grade patients with ventriculostomies require a
careful balance of the risk of hemorrhagic complications from placing patients on double antiplatelet agents versus
ischemic complications from placing patients on a single antiplatelet agent. Tirofiban can be used at the end of the coiling
procedure if platelet aggregates are seen on the stent to prevent ischemic stroke complications.
Keyword: Neuroform stent ; Ruptured intracranial aneurysms ; Tirofiban
The authors of this work have indicated that they will be discussing/presenting an unapproved or investigative use of
Merck and Co., Inc.’s Tirofiban (Aggrastat)
Paper NN13 Starting at 2:27 PM, Ending at 2:35 PM
Treatment of wide-neck distal bifurcation aneurysms using a kissing balloon technique in 11 patients
Chapot, R.·Narata, A. P.·Rogopoulos, A.·Drouineau, J.·Herbreteau, D.
Hôpital Universitaire Dupuytren
Limoges, FRANCE.
Purpose: Wide neck aneurysms may be challenging for endovascular treatment, especially when located on small
arteries. Remodelling balloons enable embolization of wide neck aneurysms, even in distal aneurysms. This treatment
may fail if the neck is extending on both division branches. In such situation, we used simultaneously two remodelling
balloons to enable endovascular treatment.
Materials and Methods: The aneurysms were treated within the last 10 months, their location was at the MCA bifurcation
(n=10) and A com (n=1). The aneurysms were unruptured and ranged in size from 5 to 12 mm. Two Hyperform® balloons
were placed in each division branch and inflated simultaneously during coil insertion.
Results: Complete aneurysmal occlusion was obtained in all attempted cases. There was no ischemic or hemorrhagic
complication. Thrombus extension without parent artery occlusion occurred in 2 patients and was managed by
antiGPIIbIIIa. Angiographic follow-up is available in 8 patients, showing a stable result.
Conclusion: The kissing balloon technique enables endovascular treatment for distal wide neck aneurysms that are
usually not considered for embolization. This technique appears to be efficient and safe in our preliminary experience.
Keyword: Aneurysm ; Wide neck ; remodeling