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<meta name="DC.Title" content="Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2572" />
<meta name="DC.Date" content="2011-09-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: An infrequent occurrence during endovascular treatment is protusion of detachable coils into the parent lumen with a subsequent thrombosis within in the parent vessel or embolic events. We report the short- and intermediate-term angiographic and clinical outcomes of patients who experience coil or loop protrusions and are managed with medical or additional endovascular treatments.

MATERIALS AND METHODS: The coil protrusions were identified by retrospective review of 256 consecutive patients treated at 3 centers with endovascular embolizations for intracranial aneurysms and subsequently categorized as grade I when a single loop or coil protruded into the parent vessel lumen less than half the parent artery diameter; grades II and III were assigned when a single coil or loop protruded more than half the parent artery diameter, respectively.

RESULTS: There were 19 patients with grade I ( n = 9), grade II ( n = 4), or grade III ( n = 6) coil protrusions. Patients with active hemodynamic compromise ( n = 6) had intracranial stents placed in addition to aspirin (indefinitely) and clopidogrel (range, 1–12 months; mean, 4.5 months) treatment. The remaining patients were placed on aspirin indefinitely. Complete aneurysm obliteration was achieved in all patients except in 3 in whom near-complete obliteration was achieved. Two patients had intraprocedural aneurysm ruptures, both of whom survived hospitalization. There were 4 deaths (4–21 days), all due to major strokes in different vascular distributions related to vasospasm (unrelated to the coil protrusion).

CONCLUSIONS: Management of coil protrusions with antiplatelet therapy and placement of stents (in selected patients) appears efficacious in preventing vessel thrombosis.

ACA
:   anterior cerebral artery
AcomA
:   anterior communicating artery
GDC
:   Guglielmi detachable coil
HH
:   Hunt and Hess
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IV
:   intravenous
mRS
:   modified Rankin Scale
PcomA
:   posterior communicating artery
SAH
:   subarachnoid hemorrhage
TIMI
:   Thrombolysis in Myocardial Infarction" />
<meta name="DC.Contributor" content="M. Abdihalim" />
<meta name="DC.Contributor" content="S.H. Kim" />
<meta name="DC.Contributor" content="A. Maud" />
<meta name="DC.Contributor" content="M. F. K. Suri" />
<meta name="DC.Contributor" content="N. Tariq" />
<meta name="DC.Contributor" content="A.I. Qureshi" />
<meta name="article:published_time" content="2011-09-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;An infrequent occurrence during endovascular treatment is protusion of detachable coils into the parent lumen with a subsequent thrombosis within in the parent vessel or embolic events. We report the short- and intermediate-term angiographic and clinical outcomes of patients who experience coil or loop protrusions and are managed with medical or additional endovascular treatments.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;The coil protrusions were identified by retrospective review of 256 consecutive patients treated at 3 centers with endovascular embolizations for intracranial aneurysms and subsequently categorized as grade I when a single loop or coil protruded into the parent vessel lumen less than half the parent artery diameter; grades II and III were assigned when a single coil or loop protruded more than half the parent artery diameter, respectively.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;There were 19 patients with grade I (&lt;i&gt;n&lt;/i&gt; = 9), grade II (&lt;i&gt;n&lt;/i&gt; = 4), or grade III (&lt;i&gt;n&lt;/i&gt; = 6) coil protrusions. Patients with active hemodynamic compromise (&lt;i&gt;n&lt;/i&gt; = 6) had intracranial stents placed in addition to aspirin (indefinitely) and clopidogrel (range, 1–12 months; mean, 4.5 months) treatment. The remaining patients were placed on aspirin indefinitely. Complete aneurysm obliteration was achieved in all patients except in 3 in whom near-complete obliteration was achieved. Two patients had intraprocedural aneurysm ruptures, both of whom survived hospitalization. There were 4 deaths (4–21 days), all due to major strokes in different vascular distributions related to vasospasm (unrelated to the coil protrusion).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Management of coil protrusions with antiplatelet therapy and placement of stents (in selected patients) appears efficacious in preventing vessel thrombosis.&lt;/p&gt;" />
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<meta name="twitter:title" content="Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: An infrequent occurrence during endovascular treatment is protusion of detachable coils into the parent lumen with a subsequent thrombosis within in the parent vessel or embolic events. We report the short- and intermediate-term angiographic and clinical outcomes of patients who experience coil or loop protrusions and are managed with medical or additional endovascular treatments.

MATERIALS AND METHODS: The coil protrusions were identified by retrospective review of 256 consecutive patients treated at 3 centers with endovascular embolizations for intracranial aneurysms and subsequently categorized as grade I when a single loop or coil protruded into the parent vessel lumen less than half the parent artery diameter; grades II and III were assigned when a single coil or loop protruded more than half the parent artery diameter, respectively.

RESULTS: There were 19 patients with grade I ( n = 9), grade II ( n = 4), or grade III ( n = 6) coil protrusions. Patients with active hemodynamic compromise ( n = 6) had intracranial stents placed in addition to aspirin (indefinitely) and clopidogrel (range, 1–12 months; mean, 4.5 months) treatment. The remaining patients were placed on aspirin indefinitely. Complete aneurysm obliteration was achieved in all patients except in 3 in whom near-complete obliteration was achieved. Two patients had intraprocedural aneurysm ruptures, both of whom survived hospitalization. There were 4 deaths (4–21 days), all due to major strokes in different vascular distributions related to vasospasm (unrelated to the coil protrusion).

CONCLUSIONS: Management of coil protrusions with antiplatelet therapy and placement of stents (in selected patients) appears efficacious in preventing vessel thrombosis.

ACA
:   anterior cerebral artery
AcomA
:   anterior communicating artery
GDC
:   Guglielmi detachable coil
HH
:   Hunt and Hess
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IV
:   intravenous
mRS
:   modified Rankin Scale
PcomA
:   posterior communicating artery
SAH
:   subarachnoid hemorrhage
TIMI
:   Thrombolysis in Myocardial Infarction" />
<meta name="og-title" property="og:title" content="Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/32/8/1392" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: An infrequent occurrence during endovascular treatment is protusion of detachable coils into the parent lumen with a subsequent thrombosis within in the parent vessel or embolic events. We report the short- and intermediate-term angiographic and clinical outcomes of patients who experience coil or loop protrusions and are managed with medical or additional endovascular treatments.

MATERIALS AND METHODS: The coil protrusions were identified by retrospective review of 256 consecutive patients treated at 3 centers with endovascular embolizations for intracranial aneurysms and subsequently categorized as grade I when a single loop or coil protruded into the parent vessel lumen less than half the parent artery diameter; grades II and III were assigned when a single coil or loop protruded more than half the parent artery diameter, respectively.

RESULTS: There were 19 patients with grade I ( n = 9), grade II ( n = 4), or grade III ( n = 6) coil protrusions. Patients with active hemodynamic compromise ( n = 6) had intracranial stents placed in addition to aspirin (indefinitely) and clopidogrel (range, 1–12 months; mean, 4.5 months) treatment. The remaining patients were placed on aspirin indefinitely. Complete aneurysm obliteration was achieved in all patients except in 3 in whom near-complete obliteration was achieved. Two patients had intraprocedural aneurysm ruptures, both of whom survived hospitalization. There were 4 deaths (4–21 days), all due to major strokes in different vascular distributions related to vasospasm (unrelated to the coil protrusion).

CONCLUSIONS: Management of coil protrusions with antiplatelet therapy and placement of stents (in selected patients) appears efficacious in preventing vessel thrombosis.

ACA
:   anterior cerebral artery
AcomA
:   anterior communicating artery
GDC
:   Guglielmi detachable coil
HH
:   Hunt and Hess
IA
:   intra-arterial
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IV
:   intravenous
mRS
:   modified Rankin Scale
PcomA
:   posterior communicating artery
SAH
:   subarachnoid hemorrhage
TIMI
:   Thrombolysis in Myocardial Infarction" />
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      <h1 class="highwire-cite-title" id="page-title">Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Abdihalim</span>, <span class="highwire-citation-author" data-delta="1">S.H. Kim</span>, <span class="highwire-citation-author" data-delta="2">A. Maud</span>, <span class="highwire-citation-author" data-delta="3">M. F. K. Suri</span>, <span class="highwire-citation-author" data-delta="4">N. Tariq</span> and <span class="highwire-citation-author" data-delta="5">A.I. Qureshi</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2011,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1392-1398; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2572 </span></div>
  
  
  
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<p id="p-3"><strong>BACKGROUND AND PURPOSE:</strong> An infrequent occurrence during endovascular treatment is protusion of detachable coils into the parent lumen with a subsequent thrombosis within in the parent vessel or embolic events. We report the short- and intermediate-term angiographic and clinical outcomes of patients who experience coil or loop protrusions and are managed with medical or additional endovascular treatments.</p>
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<p id="p-4"><strong>MATERIALS AND METHODS:</strong> The coil protrusions were identified by retrospective review of 256 consecutive patients treated at 3 centers with endovascular embolizations for intracranial aneurysms and subsequently categorized as grade I when a single loop or coil protruded into the parent vessel lumen less than half the parent artery diameter; grades II and III were assigned when a single coil or loop protruded more than half the parent artery diameter, respectively.</p>
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<p id="p-5"><strong>RESULTS:</strong> There were 19 patients with grade I (<em>n</em> = 9), grade II (<em>n</em> = 4), or grade III (<em>n</em> = 6) coil protrusions. Patients with active hemodynamic compromise (<em>n</em> = 6) had intracranial stents placed in addition to aspirin (indefinitely) and clopidogrel (range, 1–12 months; mean, 4.5 months) treatment. The remaining patients were placed on aspirin indefinitely. Complete aneurysm obliteration was achieved in all patients except in 3 in whom near-complete obliteration was achieved. Two patients had intraprocedural aneurysm ruptures, both of whom survived hospitalization. There were 4 deaths (4–21 days), all due to major strokes in different vascular distributions related to vasospasm (unrelated to the coil protrusion).</p>
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<p id="p-6"><strong>CONCLUSIONS:</strong> Management of coil protrusions with antiplatelet therapy and placement of stents (in selected patients) appears efficacious in preventing vessel thrombosis.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">ACA<span class="def-item-dt-sep"></span></dt><dd>anterior cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">AcomA<span class="def-item-dt-sep"></span></dt><dd>anterior communicating artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">GDC<span class="def-item-dt-sep"></span></dt><dd>Guglielmi detachable coil<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">HH<span class="def-item-dt-sep"></span></dt><dd>Hunt and Hess<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">IA<span class="def-item-dt-sep"></span></dt><dd>intra-arterial<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">ICH<span class="def-item-dt-sep"></span></dt><dd>intracerebral hemorrhage<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">IV<span class="def-item-dt-sep"></span></dt><dd>intravenous<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">mRS<span class="def-item-dt-sep"></span></dt><dd>modified Rankin Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">PcomA<span class="def-item-dt-sep"></span></dt><dd>posterior communicating artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">SAH<span class="def-item-dt-sep"></span></dt><dd>subarachnoid hemorrhage<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">TIMI<span class="def-item-dt-sep"></span></dt><dd>Thrombolysis in Myocardial Infarction</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2011 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/32/8/1392.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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      <div class="highwire-cite-title">Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1392-1398; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2572 </span></div>
  
  
  
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      <div class="highwire-cite-title">Short- and Intermediate-Term Angiographic and Clinical Outcomes of Patients with Various Grades of Coil Protrusions Following Embolization of Intracranial Aneurysms</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1392-1398; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2572 </span></div>
  
  
  
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