Recanalization Rates after Endovascular Coil Embolization in a Cohort of Matched Ruptured and Unruptured Cerebral Aneurysms

Abstract

<jats:p> The aim of this study was to retrospectively assess the recanalization rate, factors associated with and time taken for recanalization to occur in a matched ruptured and unruptured aneurysm population that were treated with endovascular coiling. </jats:p><jats:p> Ruptured and unruptured aneurysms treated between 2002 and 2007 were matched for aneurysm location, diameter and neck size. Recanalization rate, time to recanalize, re-treatment rate and clinical outcome were analysed. </jats:p><jats:p> Ninety-eight matched ruptured and unruptured aneurysms (49 aneurysms in each group) were studied. 46.8% of aneurysms in the ruptured group achieved complete obliteration on the initial post treatment angiogram versus 34.7% in the unruptured group. The ruptured group had a higher rate of recanalization (40.4% versus 20.4%). 25.5% of aneurysms had significant recanalization in the ruptured group versus 6.1% in the unruptured group (p=0.009). The retreatment rate was higher in the ruptured group (21.3% versus 6%). Ruptured aneurysms took a shorter time to recanalize with a mean time of 5.3±3.8 months versus 12.4±7.7months (p=0.003). Multivariate logistic regression analysis found neck size (p=0.0098), wide neck morphology (p=0.0174), aneurysm diameter (p&lt; 0.0001) and ruptured aneurysms (p=0.0372) were significant predictors of recanalization. The majority of patients in both groups had a good outcome with GOS=5 (85.7% and 83.7%) but two deaths occurred in the ruptured group. </jats:p><jats:p> Ruptured and unruptured aneurysms showed significant differences in rate, degree and timing of recanalization, thus requiring different protocols for imaging follow-up post endovascular treatment. Earlier and more frequent imaging follow-up is recommended for ruptured aneurysms. </jats:p>

Multidisciplinary management of intracranial aneurysms: The experience of Lille university hospital center

“…As in several series, the occurrence of post-embolization recanalization was more frequent in the group of patients with ruptured aneurysms [33,34]. The rate of late recanalization after embolization seems to be comparable to other large series reported in the literature [35,36].…”

Predictors of treatment failure following coil embolization of intracranial aneurysms

“…The present study identified greater aneurysm volume, PD less than 31% and initial occlusion Class of IIIb to be associated with treatment failure. There have been a number of previous studies designed to identify the factors associated with incomplete aneurysm occlusion and recurrence (Table 6) [5][6][7][8][9][10][11][12][13][14]. The list of factors associated with recurrence include SAH, younger age, aneurysm dome size, aneurysm neck diameter, aneurysm location, aneurysm multiplicity, PD, incomplete aneurysm occlusion and duration of follow-up.…”

“…A number of studies have identified larger aneurysm size to be a predictor of incomplete aneurysm occlusion and recurrence [4,7,[9][10][11][12][13][14]. Aneurysm diameter greater than 10 mm [4,10,11] and neck diameter greater than 4 mm [10,11,13] are two cut-off points that have been repeatedly shown to be associated with recurrence.…”

“…A recent systematic review estimated the overall recurrence rate following coil embolization to be approximately 20% [4]. Although a number of different factors have been implicated in aneurysm recurrence [5][6][7][8][9][10][11][12][13][14], it is still debated which of these factors is most influential. The purpose of this study is to evaluate factors that predict treatment failure after coil embolization.…”

Endovascular Coiling as the First Treatment Strategy for Ruptured Pericallosal Artery Aneurysms: Results, Complications, and Follow Up

“…Recurrence after endovascular coiling was reported to be associated with aneurysm dome size. 15,23,28) Follow-up angiographic results after complete aneurysm embolization showed recurrence rates of 14% for aneurysms º5 mm, 27% for those 5-10 mm, and 57% for those À10 mm. 28) Therefore, the lower rate of recurrence in our series may be attributable to the lower proportion of cases with aneurysms AE5 mm.…”