Review of 2 Decades of Aneurysm-Recurrence Literature, Part 1: Reducing Recurrence after Endovascular Coiling

Abstract

SUMMARY:Angiographic recurrence following endovascular therapy is an indirect measure of the potential for hemorrhage. Because patients and physicians consider recurrence to be a suboptimal outcome with some chance of future hemorrhage, much effort has been expended to reduce the incidence of recurrence. The literature regarding aneurysm recurrence following endovascular therapy, spanning 2 decades, is extensive. We will review and summarize the effort to reduce recurrence following endovascular treatment of cerebral aneurysms.

Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage

“…47 On the other hand, reconstructive techniques such as stent-assisted coiling have shown acceptable complication rates, but 59%-87% recanalization rates. 48 Still, most of these series refer to patients with unruptured aneurysms, and literature regarding ruptured giant aneurysms is scarce. In our series, 100% (2/2) of the giant aneurysms had an adverse clinical outcome at discharge.…”

Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes

“…Stent-coiling was used more frequently in aneurysms with morphologies that typically limit the use of coils because of the risk of parent artery coil prolapse, including low dome-to-neck ratios and wide aneurysm necks. Aneurysm neck Ն4 mm has been associated with a higher risk of aneurysm recanalization 18,19 ; in the MAPS Trial, all 12 stent-coiled aneurysms and 10 of 19 coiled aneurysms retreated within 1 year had necks Ն4 mm (Table 6). Conversely, no stentcoiled aneurysms with a Ͻ4-mm neck (and only 4% of coiled aneurysms with Ͻ4-mm neck) were retreated within 1 year.…”

Inter- and Intrarater Agreement on the Outcome of Endovascular Treatment of Aneurysms Using MRA

“…16 The main drawback of coiling, compared with surgery, is the risk of angiographic recurrence, reported to occur in 10%-20% of patients. [17][18][19] Second-generation coils [20][21][22][23][24][25] and, in some centers, stents and flow diverters 26 have been proposed to improve the stability of treatment. Angiographic results are still the main surrogate end point of ongoing trials on modified coils 27,28 or of other studies performed for the approval of endovascular devices.…”