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

Crobeddu, Emanuela; Lanzino, Giuseppe; Kallmes, David F.; Cloft, Harry J.

doi:10.3174/ajnr.a2958

Cited by 76 publications

(44 citation statements)

References 44 publications

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“…The relatively high recurrence rates after coiling are another major limitation of the endovascular treatment of wide-neck and/or large aneurysms. 2,3 The stent-assisted coiling (SAC) technique was developed to treat wide-neck intracranial aneurysms. 4 Several selfexpandable stents dedicated to intracranial use were introduced in the past decade, and the availability of these self-expandable intracranial stents enabled the endovascular treatment of wideneck complex aneurysms that were uncoilable previously.…”

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confidence: 99%

Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms Using Low-Profile LEO Baby Stents: Initial and Midterm Results

Aydın

Arat

Sencer

et al. 2015

AJNR Am J Neuroradiol

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confidence: 99%

Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms Using Low-Profile LEO Baby Stents: Initial and Midterm Results

Aydın

Arat

Sencer

et al. 2015

AJNR Am J Neuroradiol

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“…Furthermore, it is not absolutely clear as to for how long the aneurysm after endovascular procedures needs to be followed up (18). In the case of adequately occluded aneurysms upon control DSA after six months, further MR angiographies are considered to be an appropriate follow-up imaging tool (19). To date, our current policy is to perform a DSA after 6 months followed with serial MR angiographies, even in case of stable results up to 10 years.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic limitations in the treatment of cerebral aneurysms

Gmeiner¹,

Sonnberger²,

Pogády³

2016

BLL

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BACKGROUND: Endovascular coiling has become a standard technique in the treatment of cerebral aneurysms. The mechanisms of recurrence are incompletely understood. METHODS: In our clinical investigations we present three uncommon cases where the pathology at the base might has been underestimated in digital subtraction or magnetic resonance angiography. RESULTS: In the fi rst clinical study rehemorrhage occurred 11 years after endovascular coiling. Before rehemorrhage occurred, serial magnetic resonance angiographies had revealed a stable situation with only a small base remnant after initial endovascular treatment. In the second clinical study, intraprocedural rupture during endovascular coiling occurred and a residual angiographic occult lesion was detected only during microsurgical clipping. In the third clinical study, we again found a residual lesion during microsurgical clipping. CONCLUSION: We present three clinical studies were the pathology at the base might has been underestimated in digital subtraction angiography or magnetic resonance angiography. The incidence of angiographic occult residuals is unknown, but their clinical relevance may be important. Beside other mechanisms, these lesions might be the source of aneurysmal regrowth and hemorrhage (Fig. 4, Ref. 27). Text in PDF www.elis.sk.

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“…These results challenge previous studies reporting that aneurysm recurrence occurs mostly within 6-12 months after coil therapy and that follow-up imaging beyond that period is unnecessary. 12,13,26,27 Using 3-T MR angiography, Ferns et al 13 assessed the occurrence of late (> 4.5 years) aneurysm recanalization after coil therapy in a series of 400 patients with 440 aneurysms. The authors reported delayed aneurysm recurrence in 11 patients (2.8%), with only 3 lesions (0.7%) requiring further treatment.…”

Section: Discussionmentioning

confidence: 99%

Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

Chalouhi

Bovenzi

Thakkar

et al. 2014

JNS

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Object Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment. Methods Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images. Results Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment. Conclusions The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.

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

Cited by 76 publications

References 44 publications

Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms Using Low-Profile LEO Baby Stents: Initial and Midterm Results

Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms Using Low-Profile LEO Baby Stents: Initial and Midterm Results

Diagnostic limitations in the treatment of cerebral aneurysms

Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

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