Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms.
Aneurysm, Ruptured
/ complications
Embolization, Therapeutic
/ adverse effects
Endovascular Procedures
/ adverse effects
Humans
Intracranial Aneurysm
/ complications
Intracranial Hemorrhages
/ etiology
Platelet Aggregation Inhibitors
/ adverse effects
Retrospective Studies
Subarachnoid Hemorrhage
/ etiology
Treatment Outcome
Ventriculostomy
/ adverse effects
Aneurysm
Complication
Hydrocephalus
Intracerebral hemorrhage
Subarachnoid hemorrhage
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
23
12
2021
accepted:
22
03
2022
revised:
22
02
2022
pubmed:
30
4
2022
medline:
6
8
2022
entrez:
29
4
2022
Statut:
ppublish
Résumé
Endovascular therapy of ruptured aneurysms is regularly accompanied by periprocedural heparinization and requires the use of periprocedural antiplatelets in more complex cases. This raises concerns regarding increased bleeding risks in the case of frequently required ventriculostomy. The aim of this study was to analyze risk factors for ventriculostomy-related intracranial hemorrhages (VS-ICH) in endovascular or surgical treatment of ruptured aneurysms with a focus on antithrombotic therapy. In this retrospective analysis, we included patients admitted to our institution over a 12-year period who had received at least one ventriculostomy due to subarachnoid hemorrhage-related hydrocephalus. Patients were dichotomized into an endovascular and surgical group and rates of VS-ICH were compared. Risk factors for VS-ICH were assessed in uni- and multivariate analyses. A total of 606 ventriculostomies were performed in 328 patients. Within the endovascular group, antiplatelet therapy was used in 44.8% of cases. The overall rate of ventriculostomy-related intracranial hemorrhage was 13.1%. Endovascular treatment was associated with a higher rate of VS-ICH compared to surgical treatment (p = 0.011), but not in cases without antiplatelet therapy (p = 0.166). Application of any antiplatelet therapy (odds ratio, 2.647 [95% confidence interval, 1.141-6.143]) and number of ventriculostomies (odds ratio, 2.513 [95% confidence interval, 1.859-3.395]) were independent predictors of ventriculostomy-related hemorrhages. Our findings indicate an increased risk of VS-ICH in the endovascular group if administration of antiplatelets was required. While this aspect has to be included into treatment decision-making, it must be weighed against the benefits of endovascular techniques.
Identifiants
pubmed: 35486198
doi: 10.1007/s10143-022-01777-5
pii: 10.1007/s10143-022-01777-5
pmc: PMC9349088
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2787-2795Informations de copyright
© 2022. The Author(s).
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