Feasibility and Safety of Lyophilized Thrombin Powder for Hemostasis in Intraoperative Ruptured Intracranial Aneurysms During Endovascular Treatment: A Prospective Cohort Study

OBJECTIVE: To evaluate the clinical value, safety, and feasibility of lyophilized thrombin powder (LTP) for hemostasis in patients experiencing intraoperative aneurysms rupture (IAR) during endovascular treatment. METHODS: This prospective study analyzed 29 consecutive patients who experienced IAR during endovascular treatment and received LTP for hemostasis between January 2022 and October 2024. Data collected included patient demographics, aneurysm characteristics, IAR details, and hemostatic efficacy. Clinical outcomes and complications were systematically evaluated at 1, 3, 6, and 12 months postoperatively. RESULTS: A total of 29 patients were enrolled in this study, including 13 men and 16 women, with a median age of 64 years (interquartile range: 45.0-69.0). The intraoperative dosage of LTP ranged from 50 to 200 IU. In all cases (100%), effective hemostasis was achieved, and no postoperative rebleeding occurred. During the hospitalization, complications occurred in 10 (34.5%) patients. These included hemorrhagic hydrocephalus in 1 (3.4%) patient, vasospasm in 5 (17.2%), transient ischemic attack in 1 (3.4%), ischemic stroke in 2 (6.9%), and death in 1 (3.4%). At the 3-month follow-up, 26 (89.7%) patients showed favorable functional outcomes (modified Rankin Scale score 0-2). At both 6-month and 1-year follow-ups, 28 (96.6%) patients maintained favorable outcomes. The overall complication rate at 6 months was 15.7% (3/19), and the mortality rate at 1 year was 3.4% (1/19) patient. CONCLUSION: LTP demonstrates favorable safety and feasibility as an adjunct hemostatic measure for IAR. It may be considered when conventional hemostasis fails, though further validation of its efficacy and safety through large-scale, multicenter studies is warranted.