Safety and Efficacy of Ventriculostomy Procedures under Dual Antiplatelet Therapy in Patients Treated with Stent Assisted Coiling in Subarachnoid Hemorrhage

Abstract

AIM: Stent assisted coiling (SAC) is an alternative in the treatment of ruptured aneurysms. Stenting requires the use of dualantiplatelet agents. Hydrocephalus is a complication of subarachnoid hemorrhage (SAH) and may require ventriculostomy.Antiplatelet treatment carries a risk of hemorrhage in ventriculostomy. The anti-aggregant effect starts at least four hours after theinitial doses of treatment. However, in many studies, ventriculostomy was performed before antiplatelet treatment and hemorrhagiccomplications were related to the procedure. The aim of this study was to determine the risk of ventriculostomy related hemorrhagein patients with impaired thrombocyte function and to contribute to the literature.MATERIAL and METHODS: Between 2011 and 2016, 53 patients treated with SAC due to SAH in our clinic were retrospectivelyevaluated. Hemorrhagic complication risks due to antiplatelet therapy related to ventriculostomy were also evaluated.RESULTS: All of the ventricular catheter procedures were performed at least 1 day after the dual therapy (in average 4.3 daysafter SAC). In 5 patients 1 ventriculostomy was performed, in 2 patients 2, and in 1 patient 6 ventriculostomies were performed.Although radiological hemorrhage was present on the catheter tract in 4 patients, no temporary or permanent neurological deficitwas observed.CONCLUSION: Impaired thrombocyte functions pose a risk in ventriculostomy. Also, evaluating the risk of hemorrhage before theantiplatelet treatment reaches its full effect may lead to false results. Studies with small patient groups with anti-aggregant therapyand impaired thrombocyte functions also contribute to the literature. Larger studies regarding this subject are needed.