Association of aortic arch calcification on chest X-ray with procedural thromboembolism after coil embolization of cerebral aneurysm

• Published in: Journal of clinical neuroscience Vol. 99; pp. 373 - 378
• Main Authors: Kim, Seung Hwan, Nam, Taek Min, Lee, Sang Hyuk, Jang, Ji Hwan, Kim, Young Zoon, Kim, Kyu Hong, Kim, Do-Hyung, Lee, Chul Hee
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01-05-2022
• Subjects: Aorta, Thoracic; Aortic arch; Calcification; Cerebral aneurysm; Coil embolization; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Humans; Intracranial Aneurysm - complications; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Plaque, Atherosclerotic - complications; Retrospective Studies; Thromboembolism; X-Rays; Coil embolization; Calcification; Cerebral aneurysm; Thromboembolism; Aortic arch
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2022.03.030

•Procedural thromboembolism can occur after coil embolization of cerebral aneurysms.•It can occur due to fragmented atherosclerotic plaques in the aortic arch.•Aortic arch calcification (AoAC) can be assessed using chest X-ray.•Procedural thromboembolism was associated with AoAC.•It can occur from the fragmented atherosclerotic plaques in the aortic arch.
Procedural thromboembolism after coil embolization of a cerebral aneurysm can occur because of fragmented atherosclerotic plaques in the aortic arch. The purpose of this study was to investigate the relationship between aortic arch calcification (AoAC) observed using preoperative chest X-ray and procedural thromboembolisms after coil embolization of cerebral aneurysms. Between January 2019 and December 2020, 66 patients underwent coil embolization for cerebral aneurysms at our hospital. AoAC was assessed based on the presence of calcification using a preoperative chest X-ray. A procedural thromboembolism was defined as a new positive lesion on diffusion-weighted imaging within 7 days post-procedure. A procedural thromboembolism occurred in 34 (51.5%) patients. The thromboembolism was associated with AoAC (calcification [52.9%] vs. no calcification [6.3%], p < 0.001), aneurysm type (aneurysm with incorporated branches [63.9%] vs. sidewall aneurysm [36.7%], p = 0.047), and a longer procedural time (100.2 ± 34.1 min vs. 79.7 ± 24.9 min, p = 0.007). Multivariable logistic regression analysis showed that AoAC (adjusted odds ratio [OR], 23.566; adjusted 95% confidence interval [CI], 3.921–141.654; p = 0.001) and aneurysm type (adjusted OR, 5.501; adjusted 95% CI, 1.455–20.799; p = 0.012) were independent risk factors for procedural thromboembolism. AoAC on preoperative chest X-ray was associated with a significant increase in the procedural thromboembolism rate. Our study suggests that a procedural thromboembolism after coil embolization of cerebral aneurysms might result primarily from fragmented atherosclerotic plaques in the aortic arch. Preoperative chest X-ray could be a useful tool to predict the risk of procedural thromboembolisms.