Early major recurrence of cerebral aneurysms after satisfactory initial coiling

Abstract

Background and purpose Early major recurrence (EMR) of cerebral aneurysms treated by coiling has not been investigated. The purpose of this study is to characterize the frequency and risk factors of this phenomenon. Materials and methods A retrospective review was performed of consecutive patients who presented with ruptured and unruptured cerebral aneurysms and underwent coiling from July 2009 to June 2019 at a university hospital. We defined EMR as recurrence of the aneurysm greater than its initial size within the first 6 months of an initial satisfactory coil embolization. Patient demographics, clinical information, aneurysm characteristics, angiographic and technical details were reviewed. Results From July 2009 to June 2019, 338 aneurysms (190 unruptured aneurysms and 148 ruptured cerebral aneurysms) underwent coiling and satisfied our study criteria. Among these patients, 23 patients (19 ruptured and 4 unruptured aneurysms) were found to have recurrent aneurysm. Of those, 4 were found to have early major aneurysm regrowth occurring within 6 months after coiling (1.2%). The detection of the EMR was as early as 4 weeks and as late as 20 weeks after the initial coil embolization. The average detection time was 10 ± 7.2 weeks (mean ± SD, range:4-20 weeks). In each case, the recurrent aneurysm cavity was more than twice the initial size of presentation. All aneurysms with major recurrence were ruptured with low aspect ratios (dome height to neck ratio) and involved a communicating segment. All patients underwent successful retreatment of the recurrent aneurysm with good outcome. Conclusions Early major recurrence of treated aneurysms is a rare but important complication that harbors an impending risk of re-rupture. Early control angiography after endovascular coiling may be warranted for small ruptured aneurysms, even in cases in which the initial result seems technically satisfactory.

Impact of aneurysm diameter, angulation, and device sizing on complete occlusion rates using the woven endobridge (WEB) device: Single center United States experience

“…Ruptured aneurysms regardless of treatment modality are known to have a higher risk of recurrence compared to unruptured aneurysms. 15 There was also a significant difference in the immediate post-treatment angiographic outcome between patients with occluded aneurysms versus incomplete occlusion. The majority of patients with completely occluded aneurysms had immediate complete occlusion while all of the patients with residual aneurysms had persistent filling of the aneurysm in the arterial phase shortly after WEB deployment.…”

“…Ruptured aneurysms regardless of treatment modality are known to have a higher risk of recurrence compared to unruptured aneurysms. 15…”

Hydrophilic polymer embolization following flow diversion of cerebral aneurysms

“…Recurrence after endovascular coiling of intracranial aneurysms is a known phenomenon associated with treatment of brain aneurysms and is more commonly encountered in patients who present in a ruptured state, with wide-neck aneurysms, larger sized aneurysms, or incompletely occluded aneurysms at the initial treatment. [12][13][14] Endovascular flow diversion has been shown to have high technical success in the definitive closure of intracranial aneurysms. [15][16][17][18] As our patient demonstrated major recurrence of her aneurysm several years after coiling of her initially ruptured aneurysm, endovascular flow diversion was selected as the preferred modality to achieve aneurysm closure.…”

“…Challenges associated with repeat coiling are the potential for coil migration in wide-neck aneurysms with shallow luminal recurrences. 11,12 Given the unfavorable anatomy for repeat coiling and the difficulty of surgical treatment, a flow diverter stent was recommended. A Flexor® Shuttle® Sheath (Cook Medical, Bloomington, IN) was placed in the right internal carotid artery.…”

Management of Unruptured Intracranial Aneurysms and Brain Arteriovenous Malformations

“…Incomplete occlusion and subsequent recanalization rates following coil embolization and surgical clipping 31 have raised concerns regarding the durability of endovascular treatment for cerebral aneurysms. 32,33 Risk factors for aneurysm recurrence after coiling include wide-neck aneurysms (≥4 mm), large aneurysms (>10 mm), and incomplete aneurysm occlusion at the time of treatment. 34 Residual microcirculatory flow may remain even in tightly packed lesions.…”