Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

Muskens, Ivo S.; Hertgers, Omar; Nijeholt, Geert J. Lycklama à; Broekman, Marike L D; Moojen, Wouter A.

doi:10.1093/neuros/nyy455

Cited by 16 publications

(6 citation statements)

References 45 publications

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“…3 Conversely, retreatment of previously stented aneurysms is challenging for both neurosurgeons and neurointerventionalists due to its questionable efficacy and safety. 4,5 Thus, neither conventional clipping nor coiling has provided reasonable outcomes as a retreatment technique for recurrent aneurysms after SAC.…”

mentioning

confidence: 99%

Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling

Park

Yeon

Kim

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Flow-diverter treatment for previously stented aneurysms has been reported to be less effective and prone to complications. In this study, we evaluated the effectiveness and safety of flow diverters for recurrent aneurysms after stent-assisted coiling. MATERIALS AND METHODS:Patients who underwent flow-diverter placement for recurrent aneurysms after stent-assisted coiling between March 2015 and March 2019 were recruited. Clinical and radiographic characteristics and clinical and angiographic outcomes were retrospectively evaluated.RESULTS: Among 133 patients who underwent flow-diverter insertion, 17 (male/female ratio = 5:12; mean age, 53.8 years) were treated for recurrent aneurysms after stent placement with (n ¼ 16) or without (n ¼ 1) coiling. Eight patients initially presented with subarachnoid hemorrhage; 7, with headache; and 2, with visual field defects. Angiographic morphology included large/giant saccular in 12 patients, dissecting in 2, fusiform in 1, traumatic pseudoaneurysm in 1, and ruptured blood blister-like aneurysm in 1. The duration between the first treatment and flow-diverter placement ranged from 2 weeks to 15 months (median, 6 months). Flow-diverter placement was successful in all cases without any complications. All patients had favorable outcomes (mRS, 0-2), without any newly appearing symptoms. Aneurysms were followed up with conventional angiography at least once in 6-18 months. Sixteen aneurysms showed complete occlusion, and 1 aneurysm was enlarged. CONCLUSIONS:Results from this case series investigating flow-diverter placement for recurrent aneurysms after stent-assisted coiling suggested that the procedure is safe and effective. Further study in a larger population may be warranted.

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confidence: 99%

Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling

Park

Yeon

Kim

et al. 2020

AJNR Am J Neuroradiol

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“…This result provides robust evidence that smokers harboring IAs even after successful aneurysm coiling should be strongly supported to stop smoking. 10 11 18 Importantly, in our analysis, smoking was the only modifiable factor associated with target aneurysm recanalization.…”

Section: Discussionmentioning

confidence: 60%

“…Evidence from a recent meta-analysis indicates a procedural mortality risk for retreatment of a previously coiled ruptured aneurysm of 0.8% for coiling after coiling, 2.2% for flow diverter after coiling, and 5.6% for surgery after coiling, with an overall combined retreatment morbidity/mortality risk of 6-11%. 10 In order to manage aneurysm recanalization appropriately, it is important to evaluate patient, aneurysm, or procedure associated factors. While smoking is clearly associated with the development and rupture of IA, its role in aneurysm recurrence remains unclear.…”

Section: Hemorrhagic Strokementioning

confidence: 99%

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Patient and aneurysm factors associated with aneurysm recanalization after coiling

Piérot

Barbe

Thierry

et al. 2021

J NeuroIntervent Surg

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BackgroundOne limitation of the endovascular treatment of intracranial aneurysms is aneurysm recanalization. The Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) study is a prospective multicenter cohort study evaluating the factors associated with recanalization after endovascular treatment.MethodsThe current analysis is focused on patients treated by coiling or balloon-assisted coiling (BAC). Postoperative, mid-term vascular imaging, and evolution of aneurysm occlusion were independently evaluated by two neuroradiologists. A 3-grade scale was used for aneurysm occlusion (complete occlusion, neck remnant, and aneurysm remnant) and for occlusion evolution (improved, stable, and worsened). Recanalization was defined as any worsening of aneurysm occlusion.ResultsBetween December 2013 and May 2015, 16 French neurointerventional departments enrolled 1289 patients. A total of 945 aneurysms in 908 patients were treated with coiling or BAC. The overall rate of aneurysm recanalization at mid-term follow-up was 29.5% (95% CI 26.6% to 32.4%): 28.9% and 30.3% in the coiling and BAC groups, respectively. In multivariate analyses factors independently associated with recanalization were current smoking (36.6% in current smokers vs 24.5% in current non-smokers (OR 1.8 (95% CI 1.3 to 2.4); p=0.0001), ruptured status (31.9% in ruptured aneurysms vs 25.1% in unruptured (OR 1.5 (95% CI 1.1 to 2.1); p=0.006), aneurysm size ≥10 mm (48.8% vs 26.5% in aneurysms <10 mm (OR 2.6 (95% CI 1.8 to 3.9); p<0.0001), wide neck (32.1% vs 25.8% in narrow neck (OR 1.5 (95% CI 1.1 to 2.1); p=0.02), and MCA location (34.3% vs 28.3% in other locations (OR 1.5 (95% CI 1.0 to 2.1); p=0.04).ConclusionsSeveral factors are identified by the ARETA study as playing a role in aneurysm recanalization after coiling: current smoking, aneurysm status (ruptured), aneurysm size (≥10 mm), neck size (wide neck), and aneurysm location (middle cerebral artery). This finding has important consequences in clinical practice.Trial registration numberURL: http://www.clinicaltrials.gov; Unique Identifier: NCT01942512.

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“…safety. 10) The risk of rupture or re-rupture of recurrent aneurysms after an FDS is uncertain. Additionally, the retreatment of recurrent aneurysms after an FDS is rare and has technical limitations.…”

Section: Introductionmentioning

confidence: 99%

Retreatment of a recurrent giant aneurysm of the internal carotid artery after treatment with a flow-diverting stent

Kim

Park

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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Flow-diverting stents (FDSs) have proven advantageous for the treatment of large, fusiform, and dissecting aneurysms that are otherwise difficult to treat. Retreatment strategies for recurrent large or giant aneurysms after FDSs are limited to overlapping implantation of an additional FDS or definitive occlusion of the parent vessel. We report a recurrent giant aneurysm that was initially treated with an FDS with coils and was successfully treated with an additional FDS. Visual symptoms due to the mass effect of the recurrent aneurysm were completely resolved, and follow-up digital subtraction angiography revealed complete obliteration of the aneurysm. Additional FDS implantation for the retreatment of incompletely occluded aneurysms after the initial FDS treatment may be feasible and safe. Further studies are required to validate these results.

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Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

Cited by 16 publications

References 45 publications

Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling

Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling

Patient and aneurysm factors associated with aneurysm recanalization after coiling

Retreatment of a recurrent giant aneurysm of the internal carotid artery after treatment with a flow-diverting stent

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