Perioperative management of coagulation and fibrinolytic activity in endosaccular embolization of cerebral aneurysms

Endosaccular embolization is an innovative and effective treatment for surgically formidable cerebral aneurysms. Platinum microcoils are soft, easily fit to complex configuration of aneurysms, highly thrombogenic, so that suitable for this purpose. Recently developed Guglielmi detachable coils have more advantages in terms of retrievability and electrothrombotic effect. However, distal migration of intraaneurysmal thrombus produces thromboembolism in normal cerebral arteries, leading to neurological deficits. Three cases are presented in which thromboembolic complications occurred during or after embolization of cerebral aneurysms with platinum microcoils. Emergent fibrinolytic treatment resolved neurological deficits in each case without any other complications. From these lessons, a protocol of intra- and postoperative anticoagulation and antiplatelet therapy is presented. In conclusion, perioperative management of fibrinolytic and coagulation activity is extremely important in preventing thromboembolic complication and obtaining successful result.