Hemorrhagic Complications Associated with Ventriculostomy in Patients Undergoing Endovascular Treatment for Intracranial
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ORIGINAL ARTICLE
Hemorrhagic Complications Associated with Ventriculostomy in Patients Undergoing Endovascular Treatment for Intracranial Aneurysms: A Single-Center Experience Jack M. Leschke1 • Andrew Lozen2 • Mayank Kaushal3 • Akinwunmi Oni-Orisan2 Mazen Noufal1 • Osama Zaidat1 • Glen A. Pollock2 • Wade M. Mueller2
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Ó Springer Science+Business Media New York 2016
Abstract Background Currently, a complete understanding of postventriculostomy hemorrhagic complications in subarachnoid hemorrhage due to ruptured aneurysms remains unknown. The present study evaluates the impact of periprocedural risk factors on rates of external ventricular drain (EVD)-associated hemorrhage in the setting of endovascular treatment of intracranial aneurysms. Methods A retrospective chart review of 107 patients who underwent EVD placement within 24 h of endovascular coiling was performed. CT of head without contrast was obtained after drain placement and before endovascular treatment. Post-procedural CT was also obtained within 48 h of embolization and was reviewed for new/worsened track hemorrhages. Chi-squared test was used in evaluation. Results Ninety-three of the 107 patients reviewed met the inclusion criteria. Four (25%) of the 16 patients on antiplatelet medications at presentation experienced post-EVD hemorrhage compared to 11 (14.3%) of 77 that were not (p = 0.29). Of the 13 patients given intraprocedural antiplatelets, 3 (23.1%) demonstrated hemorrhage compared to 12 (15%) of 80 not administered these medications (p = 0.46). Further, of 36 patients with intraprocedural anticoagulation, 6 (16.7%) exhibited hemorrhage compared
& Mayank Kaushal [email protected] 1
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
2
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
3
Department of Biomedical Engineering, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI 53233, USA
to 9 (15.8%) of 57 in those without (p = 0.91). In 17 patients who received DVT prophylaxis, 2 (11.8%) exhibited hemorrhage compared to 13 (17.1%) of 76 who did not (p = 0.59). No post-EVD hemorrhage had attributable neurologic morbidity. Conclusion Our results, demonstrating no significant risk factor related to EVD-associated hemorrhage rates, support the safety of EVD placement in the peri-endovascular treatment period. Keywords Subarachnoid hemorrhage Endovascular treatment External ventricular drain Ventriculostomy Intracranial aneurysm
Introduction Endovascular management has gained widespread acceptance for the treatment of intracranial aneurysms [1–6]. The rising adoption of endovascular techniques has warranted studies looking at complications specific to these procedures. A major concern is hemorrhage associated with the technique itself as well as any additional interventions that might be required [7]. This can happen if the need to maintain optimal anticoagulation during and after the endovascular procedure is not in concert with the hemostatic requirements of perform
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