Published online before print January 26, 2012, doi: 10.3174/ajnr.A2989
AJNR 2012 33: E28
F. Xua and D. Songa
aDepartment of Neurosurgery
Huashan Hospital
Fudan University
Shanghai, China
We read with interest the recent article entitled "Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms: A Qualitative, Systematic Review of the Literature" by Bodily et al.1 The authors reviewed the literature to evaluate the safety and efficacy of stent-assisted coil embolization of acutely ruptured intracranial aneurysms. They collected 17 articles that included at least 5 patients each with ruptured aneurysms who were treated acutely with stents or stent-assisted coiling. However, among these 17 articles, Kim et al2 reported only 1 patient with a ruptured intracranial aneurysm. Yahia et al3 reported 4 patients with ruptured wide-neck aneurysms. Moreover, Yahia et al3 used a staged stent placement procedure for these aneurysms. They first used coils to secure the aneurysm, followed by stent-assisted coiling 4–6 weeks after the initial procedure. It was not described in the paper by Bodily et al, "a single intervention for placement of an uncovered stent and coils."
Bodily et al1 also stated that none of the patients received antiplatelet therapy or heparin before the procedure. However, among the 17 articles, Tumialan et al4reported that all patients in their series were given a loading dose of 325 mg of aspirin and 375 mg of clopidogrel before undergoing common femoral artery sheath placement. We believe that the authors did not interpret the studies correctly, and we would like them to comment on this observation.
References
- Bodily KD, Cloft HJ, Lanzino G, et al. Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 2011; 32: 1232–36 » Abstract/FREE Full Text
- Kim BM, Chung EC, Park SI, et al. Treatment of blood blister-like aneurysm of the internal carotid artery with stent-assisted coil embolization followed by stent-within-a-stent technique: case report. J Neurosurg 2007; 107: 1211–13 » CrossRefMedline
- Yahia AM, Gordon V, Whapham J, et al. Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 2008; 8:19–30 » CrossRef » Medline
- Tumialan LM, Zhang YJ, Cawley CM, et al. Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: a cautionary report. J Neurosurg 2008; 108: 1122–29 » CrossRef » Medline
Reply
Published online before print January 26, 2012, doi: 10.3174/ajnr.A2999
AJNR 2012 33: E29
K. Bodilya
aHigh Desert Radiology
Kingman, Arizona
D.F. Kallmesb
bMayo Clinic
Rochester, Minnesota
We appreciate the authors' input. Most important, reference 19 was erroneously switched in our manuscript with an article that was excluded. Both studies were written by authors named Kim, published in 2007. The reference you question from Kim BM et al was not included in the data used in our analysis because it did not, as you point out, meet the inclusion criteria. A report by Kim YJ did meet the inclusion criteria and was included in our analysis. This article should replace reference 19 in our references section:
19. Kim YJ. Early experiences of Neuroform stent-assisted coiling in ruptured intracranial aneurysms. Interv Neuroradiol 2007;13:31–44
The report by Yahia et al does include 5 ruptured aneurysms. In 1 patient, a recurrent aneurysm was also ruptured as indicated in the last paragraph of the "Results" section of that article. This patient did not have a complication related to stent-assisted coiling and does not change the outcome of our analysis if removed from the data.
We agree with your point that 6 patients reported by Tumialan et al did have antiplatelet therapy before undergoing common femoral artery sheath placement. This is discrepant with our statement that "None of the patients received antiplatelet therapy or heparin before the procedure." However, this was an observation and not an inclusion criterion. Most of the patients (326 of 329) in our analysis did receive dual antiplatelet therapy, administered at various times. Furthermore, the report of Tumialan et al only includes 6 patients, none of whom had reported intraprocedural complications. The timing of administration of dual antiplatelet therapy, therefore, is not material for these patients and does not change our conclusions.
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