Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis

Rizvi, Asim; Seyedsaadat, Seyed Mohammad; Alzuabi, Muayad; Murad, M. Hassan; Kadirvel, Ramanathan; Brinjikji, Waleed; Kallmes, David F.

doi:10.3174/ajnr.a6568

Cited by 8 publications

(8 citation statements)

References 34 publications

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“…Recent studies demonstrated a very low incidence of rebleeding for ruptured aneurysms and bleeding for unruptured aneurysms after coil embolization 48 , 49) along with risk factors for the aneurysm rupture. 48) Although the correlation between bleeding from coiled aneurysms and recanalization has not been well clarified, we believe that aggressive intervention for recanalized aneurysms is one of the reasons for this low rupture rate of coil aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Craniograms in Discriminating Coiled Intracranial Aneurysms Requiring Retreatment

Yasuda

Satow

Hashimura

et al. 2022

Neurol. Med. Chir.(Tokyo)

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While endovascular coil embolization has become one of the major therapeutic modalities for intracranial aneurysms, long-term imaging follow-up is required because of the higher rate of retreatment compared with surgical clipping. The purpose of this study was to show the usefulness of craniograms to discriminate coiled intracranial aneurysms that required retreatment. Under the study protocol approved by institutional review board, a retrospective review of the medical record was done regarding coil embolization for intracranial aneurysms performed between January 2014 and December 2018. Coil embolization performed as the initial treatment and followed up for more than 1 year without additional treatment, and those performed as retreatment after the initial coil embolization performed at our institution were recruited. Craniograms obtained just after the initial treatment were compared with those obtained just before the additional treatment in the retreated cases and compared with the latest ones in the nonrecurrence cases. Correlation between the morphological changes in the coil mass on the craniograms and retreatments was evaluated. During the study period, 288 coil embolization procedures for intracranial aneurysms were performed. From these, 191 treatments that were followed up for more than 1 year without any additional treatments and 30 retreatments were included. Morphological change of the coil mass was observed in 4 of the 191 non-recurrence treatments and 26 of the 30 retreatments, which was significantly correlated with retreatments (p <0.001). Craniogram was a useful modality in following up the coiled intracranial aneurysms to detect those required retreatments.

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Section: Discussionmentioning

confidence: 99%

Usefulness of Craniograms in Discriminating Coiled Intracranial Aneurysms Requiring Retreatment

Yasuda

Satow

Hashimura

et al. 2022

Neurol. Med. Chir.(Tokyo)

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“…They concluded that while unruptured aneurysms with a remnant after endovascular treatment had a very low risk of rupture (0.6%), ruptured aneurysms had a higher risk of rerupture (3.4%) from a neck remnant. In their systematic review and metaanalysis, given a 5% retreatment rate, Rizvi et al 29 showed that spontaneous rupture of previously unruptured, small-and medium-sized, well-treated aneurysms was exceedingly rare (0.25%) after coiling. However, it should be taken into consideration that the retreatment of aneurysms after endovascular treatment due to the growing residual or recanalization prevents to be faced more reruptured cases.…”

Section: Discussionmentioning

confidence: 99%

Flow diverter stents in the treatment of recanalized intracranial aneurysms

et al. 2021

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Background We assessed the safety and efficacy of flow diverter stents (FDSs) in the treatment of recanalized or residual intracranial aneurysms treated endovascularly. Materials & Methods Patients whose recanalized or residual aneurysms were treated with FDSs in five tertiary hospitals were reviewed retrospectively. The patients’ demographic data, aneurysm characteristics, types of previous treatment, and clinical complications, or serious adverse events associated with FDSs, as well as the results of neurological and angiographic follow-up assessments, were recorded. Results Eighty-six patients (37 males) with 87 aneurysms were included in this study. Eighty (91.9%) aneurysms were in the anterior and seven (8.1%) in the posterior circulation. The initial treatment methods were the primary coiling or balloon remodeling technique in 69 (79.3%) and stent-assisted coiling in 18 (20.7%) aneurysms. The endovascular procedure was successful in all patients. Complications occurred in four patients, for a total complication rate of 4.6%. A technical complication developed in one patient (1.2%). An in-stent thrombosis treated with tirofiban was seen in two cases. Late in-stent stenosis exceeding 50% was treated with balloon angioplasty in one patient. The mean length of follow-up was 21.0 months. The first angiographic follow-up (3–6 months) revealed the complete occlusion of 74 aneurysms (85.1%). While 76 aneurysms (87.4%) were occluded at the last angiographic follow-up (mean: 26.0 months), 11 aneurysms (12.6%) were still filling. Morbimortality was zero. Conclusion The drawback of endovascular treatment is aneurysmal remnants or recurrences, which is safely and durably amenable to flow diversion.

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“…During a mean follow-up duration of 3.2 years, 12 patients (0.25%) experienced rupture of a UIA after the initial year of treatment resulting in rupture rate of 0.48 (95% CI 0.45-0.51) per 100 patient-years. 74 Two registry based retrospective studies provide data on risk of aneurysm rerupture or intracranial haemorrhage after microsurgical occlusion or endovascular of UIA. A nationwide retrospective cohort study in South Korea used health insurance data for 11,777 patients undergoing surgical clipping and 14,634 patients undergoing endovascular treatment between 2008 through 2014.…”

Section: Additional Informationmentioning

confidence: 99%

“…The systematic review on long-term follow-up after endovascular treatment of UIA found a retreatment rate of 4.9% (95% CI 4.3-5.5), but also noted the lack of systematic nature of follow-up and short duration of follow-up (mean 3.2 years) as limitations of the studies included in the review. 74 In a study using administrative data from all non-federal hospitalisations in California (2005)(2006)(2007)(2008)(2009)(2010)(2011) and Florida (2005-2014) that was published after the data search from the above mentioned systematic review, retreatment rates for UIA patients were 4.6% (95% CI 3.9-5.4) after surgical clipping and 10.6% (95% CI 9.8-11.4) after endovascular occlusion. 33 In the retrospective cohort study from South Korea the probabilities of retreatment at 7 years were 3.2% (95% CI 2.9-3.5) in the surgical clipping group and 4.9% (95% CI 4.6-5.3) in the endovascular coiling group.…”

Section: Additional Informationmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms

Etminan

Sousa

Tiseo

et al. 2022

European Stroke Journal

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Unruptured intracranial aneurysms (UIA) occur in around 3% of the population. Important management questions concern if and how to perform preventive UIA occlusion; if, how and when to perform follow up imaging; and non-interventional means to reduce the risk of rupture. Using the Standard Operational Procedure of ESO we prepared guidelines according to GRADE methodology. Since no completed randomised trials exist, we used interim analyses of trials, and meta-analyses of observational and case-control studies to provide recommendations to guide UIA management. All recommendations were based on very low evidence. We suggest preventive occlusion if the estimated 5-year rupture risk exceeds the risk of preventive treatment. In general, we cannot recommend endovascular over microsurgical treatment, but suggest flow diverting stents as option only when there are no other low-risk options for UIA repair. To detect UIA recurrence we suggest radiological follow up after occlusion. In patients who are initially observed, we suggest radiological monitoring to detect future UIA growth, smoking cessation, treatment of hypertension, but not treatment with statins or acetylsalicylic acid with the indication to reduce the risk of aneurysm rupture. Additionally, we formulated 15 expert-consensus statements. All experts suggest to assess UIA patients within a multidisciplinary setting (neurosurgery, neuroradiology and neurology) at centres consulting >100 UIA patients per year, to use a shared decision-making process based on the team recommendation and patient preferences, and to repair UIA only in centres performing the proposed treatment in >30 patients with (ruptured or unruptured) aneurysms per year per neurosurgeon or neurointerventionalist. These UIA guidelines provide contemporary recommendations and consensus statement on important aspects of UIA management until more robust data come available

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Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 34 publications

Usefulness of Craniograms in Discriminating Coiled Intracranial Aneurysms Requiring Retreatment

Usefulness of Craniograms in Discriminating Coiled Intracranial Aneurysms Requiring Retreatment

Flow diverter stents in the treatment of recanalized intracranial aneurysms

European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms

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