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This raises concerns regarding increased bleeding risks in the case of frequently required ventriculostomy. The aim of this study was to analyze risk factors for ventriculostomy-related intracranial hemorrhages (VS-ICH) in endovascular or surgical treatment of ruptured aneurysms with a focus on antithrombotic therapy. In this retrospective analysis, we included patients admitted to our institution over a 12-year period who had received at least one ventriculostomy due to subarachnoid hemorrhage-related hydrocephalus. Patients were dichotomized into an endovascular and surgical group and rates of VS-ICH were compared. Risk factors for VS-ICH were assessed in uni- and multivariate analyses. A total of 606 ventriculostomies were performed in 328 patients. Within the endovascular group, antiplatelet therapy was used in 44.8% of cases. The overall rate of ventriculostomy-related intracranial hemorrhage was 13.1%. Endovascular treatment was associated with a higher rate of VS-ICH compared to surgical treatment (<jats:italic>p<\/jats:italic>\u2009=\u20090.011), but not in cases without antiplatelet therapy (<jats:italic>p<\/jats:italic>\u2009=\u20090.166). Application of any antiplatelet therapy (odds ratio, 2.647 [95% confidence interval, 1.141\u20136.143]) and number of ventriculostomies (odds ratio, 2.513 [95% confidence interval, 1.859\u20133.395]) were independent predictors of ventriculostomy-related hemorrhages. Our findings indicate an increased risk of VS-ICH in the endovascular group if administration of antiplatelets was required. While this aspect has to be included into treatment decision-making, it must be weighed against the benefits of endovascular techniques.<\/jats:p>","DOI":"10.1007\/s10143-022-01777-5","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T04:56:46Z","timestamp":1651208206000},"page":"2787-2795","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0788-4681","authenticated-orcid":false,"given":"Moritz","family":"Lenschow","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niklas","family":"von Spreckelsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergej","family":"Telentschak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Kabbasch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Goldbrunner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Grau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,4,29]]},"reference":[{"issue":"6","key":"1777_CR1","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1227\/NEU.0b013e318246a4b1","volume":"70","author":"PS Amenta","year":"2012","unstructured":"Amenta PS, Dalyai RT, Kung D, Toporowski A, Chandela S, Hasan D, Gonzalez LF, Dumont AS, Tjoumakaris SI, Rosenwasser RH (2012) Stent-assisted coiling of wide-necked aneurysms in the setting of acute subarachnoid hemorrhage: experience in 65 patients. 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The University of Cologne Research Ethics Committee has confirmed that no ethical approval is required (reference number: 21\u20131262).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"Chrisoph Kabbasch is a consultant for Acandis and a proctor for Microvention. The other authors have no relevant financial or non-financial interests to disclose.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}