Factors associated with rebleeding after coil embolization in patients with aneurysmal subarachnoid hemorrhage.

OBJECTIVE: Aneurysmal subarachnoid hemorrhage (aSAH) has a high mortality rate, and hemorrhage amounts and perioperative rebleeding importantly determines prognosis. However, despite adequate treatment, prognosis is poor in many ruptured aneurysm cases. In this study, we identified and evaluated factors related to perioperative rebleeding in patients with aSAH. METHODS: The medical and surgical records of 166 patients that underwent endovascular embolization for a ruptured cerebral aneurysm at a single institution from 2014 to 2016 were retrospectively analyzed to identify risk factors of rebleeding. All patients were examined for risk factors and evaluated for increased hemorrhage by brain computed tomography at 3 days after surgery. RESULTS: This series included 54 men (32.5%) and 112 women (67.5%) of mean age 58.3±14.3 years. After procedures, 26 patients (15.7%) experienced rebleeding, and 1 of these (0.6%) experienced an intraoperative aneurysmal rupture. External ventricular drainage (EVD) (odds ratio [OR] 5.389, [95% confidence interval (CI) 1.171- 24.801]) and modified Fisher grade (OR 2.037, [95% CI 1.077-3.853]) were found to be independent risk factors of rebleeding, and perioperative rebleeding was strongly associated with patient outcomes (p＜0.001). Conclusions: We concluded the rebleeding risk after aSAH is greater in patients with large hemorrhage amounts and a high pre-operative modified Fisher grade, and thus, we caution neurosurgeons should take care in such cases.

Safety of heparin loading during endovascular embolization in patients with aneurysmal subarachnoid hemorrhage.

OBJECTIVE: Of the complications that can occur during endovascular surgery in aneurysmal subarachnoid hemorrhage (aSAH) patients, thromboembolism remains a particular challenge for many surgeons. Heparin has been widely used for its prevention, but it has not been able to eliminate concerns about bleeding. Therefore, in this study, we tried to determine the risk of rebleeding associated with heparin use. METHODS: We retrospectively analyzed the medical and surgical records of 109 patients that underwent endovascular embolization for a ruptured cerebral aneurysm at a single institution from 2010 to 2014. These patients were divided into two groups according to whether heparin was loaded or not, to determine the effect of heparin on rebleeding and to identify other risk factors of rebleeding. RESULTS: This series included 40 men (36.7 %) and 69 women (63.3 %) of mean age 57.9 ± 14.8 years. In 80 patients (73.4 %), endovascular embolization was conducted using an intraoperative bolus of 5000 units of heparin, whereas in the other 29 (26.6 %) endovascular embolization was performed without an intraoperative heparin bolus. After procedures, 16 patients (14.7 %) experienced rebleeding and 2 (1.8 %) a thromboembolic event. Intraoperative heparin loading (OR 0.683 [95 % CI 0.199-2.338]) was not found to be related to postoperative rebleeding. Rather, logistic regression analysis showed preoperative modified Fisher grade (OR 2.037 [95 % CI 1.077-3.853]) and external ventricular drainage (OR 5.389 [95 % CI 1.171-24.801]) independently predicted rebleeding. CONCLUSIONS: Heparin loading during endovascular treatment of ruptured cerebral aneurysms did not affect rebleeding. We conclude heparin loading to prevent thromboembolism during endovascular treatment may be considered a good option in aSAH patients.

Influence of Antithrombotic Medication on the Risk of Chronic Subdural Hematoma Recurrence after Burr-Hole Surgery.

OBJECTIVE: Chronic subdural hematoma (CSDH) is one of the most common intracranial hemorrhages. It can be managed with a simple surgical treatment such as burr-hole trephination and drainage. However, it has a relatively high recurrence rate. The mechanisms and risk factors for the recurrence have not yet been clearly identified and studies have reported varying results. METHODS: We analyzed 230 patients with CSDH who were treated with burr-hole trephination and drainage at our institution from March 2011 to March 2016. The patients were divided into recurrence and non-recurrence groups and the medical records of each group were used to analyze the risk factors associated with CSDH recurrence. RESULTS: After burr-hole trephination and drainage, CSDH recurrence was observed in 49 (21.3%) of the 230 patients. In univariate analysis, none of the factors showed statistical significance with respect to CSDH recurrence. In multivariate analysis, preoperative antithrombotic medication was the only independent risk factor for CSDH recurrence (odds ratio, 2.407; 95% confidence interval, 1.047-5.531). CONCLUSION: The present study found that preoperative antithrombotic medication was independently associated with CSDH recurrence.