The Utility of Diffusion-Weighted MRI Lesions to Compare the Effects of Different Heparinization Schemes in Intracranial Aneurysms Treated by Endovascular Intervention

Abstract

Objective: Heparinization is applied to prevent ischemic complications in the endovascular treatment of intracranial aneurysms, but there is no unified heparinization scheme. Diffusion-weighted imaging (DWI) can be used to evaluate ischemia after endovascular therapy for intracranial aneurysms. The goal of this study is to apply DWI to evaluate the effects of different heparinization schemes on intracranial aneurysms treated with endovascular therapy. Methods: We retrospectively reviewed 141 patients with 149 aneurysms treated with endovascular interventions from July 2019 to April 2020 at our center, including 96 aneurysms treated with local heparinization and 53 aneurysms treated with systemic heparinization. We collected the basic information of the patients, including age, sex, comorbidities, and aneurysm characteristics, and associated treatment data. New ischemic lesions detected by DWI were categorized belonging to four types. Multivariate logistic regression was used to compare the effects of different heparinization schemes on intracranial aneurysms treated with endovascular therapy. Results: There were no significant differences in age, sex, hypertension, diabetes, and aneurysm size or location between the two groups. The incidence and distribution types of DWI abnormalities in the local heparinization groups and systemic heparinization groups were not significantly different (P > 0.05). There was a correlation between the laser engraving stent and postoperative DWI abnormalities (P < 0.003). Multivariate logistic regression analysis showed that the laser engraving stent was significantly correlated with postoperative DWI abnormalities (odds ratio, 4.71; 95% CI: 1.51-14.58; P = 0.007). Conclusion: Compared with systemic heparinization, local heparinization does not increase the incidence of DWI abnormalities after endovascular treatment, and its application in this group of patients is safe and effective.

Keywords: diffusion-weighted imaging; endovascular treatment; heparinization; intracranial aneurysm; vascular disorders.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a shared affiliation, with several of the authors YW, HY at time of review.

Copyright © 2020 Zhang, Zhou, Liu, Ding, Wang and Yang.

Figures

Figure 1

(A) A 46-year-old male patient with anterior communicating aneurysm underwent pure spring coil embolization under systemic heparinization, and the postoperative result indicated the acute cerebral infarction focus in the left parietal temporal lobe. (B) A 48-year-old male patient with right posterior communicating aneurysm underwent stent-assisted embolization under local heparinization, and the postoperative result indicated the acute cerebral infarction in the right lateral ventricle. (C) A 54-year-old male patient with right posterior communicating aneurysm underwent pure spring coil embolization under local heparinization, and the postoperative result indicated the abnormal DWI signals in the bilateral parietal lobes. (D) A 55-year-old female patient with a right middle cerebral aneurysm underwent stent-assisted embolization under systemic heparinization, the postoperative result indicated the acute cerebral infarction in the right parietal temporal lobe and the left frontal lobe.