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Original research
Anatomical results, rebleeding and factors that affect the degree of occlusion in ruptured cerebral aneurysms after endovascular therapy
  1. Eduardo Murias Quintana1,
  2. Alberto Gil Garcia1,
  3. Pedro Vega Valdés1,
  4. Hugo Cuellar2,
  5. Ángela Meilán Martínez1,
  6. Antonio Saiz Ayala1,
  7. Serafin Costilla Garcia1,
  8. Dolores Escudero Augusto3,
  9. Julio Cesar Gutierrez Morales4,
  10. Antonio López García4
  1. 1Department of Radiology—Interventional Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
  2. 2Department of Neurosurgery, LSU Health Sciences Center, Shreveport, Louisiana, USA
  3. 3Department of Critical Care, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
  4. 4Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
  1. Correspondence to Dr Eduardo Murias Quintana, Department of Radiology—Interventional Neuroradiology, Hospital Universitario Central de Asturias, Julián Clavería s/n, Oviedo, Asturias 33006, Spain; emuriass{at}hotmail.com

Abstract

Object To present a series of ruptured cerebral aneurysms in consecutive non-selected patients treated with endovascular therapy, analyzing the initial degree of occlusion, its anatomical evolution mid-term and the variables that could statistically affect them.

Methods 251 aneurysms were first treated with coiling (embolization). 203 patients were followed up with conventional angiography for 6–8 months after the initial treatment and 182 were followed up with three-dimensional time of flight MR angiography at18–24 months. Postoperative and mid-term anatomical results were evaluated anonymously and independently using the modified Montreal Scale.

Results The initial rate of complete occlusion was 70.9%, with rates of neck remnants and aneurysm remants of 18.3% and 10.7%, respectively. The recurrence rate was 13% after 6 months and 2% between 6 months and 2 years. The rate of retreatment was 11%. Statistically, the variables that were found to be related to the initial degree of occlusion were the use of a remodeling balloon technique (p=0.012), the size of the aneurysm neck (p=0.044) and the size of the aneurysm (p=0.004). The recanalization rate at mid-term depended on the size of the aneurysm. Although aneurysms with partial occlusion initially tended to evolve to a worse degree of closure than those with complete occlusion initially, the relationship was not statistically significant (p=0.110).

Conclusions Embolized aneurysms can develop a worse degree of closure even when the initial occlusion is complete. The degree of occlusion depends directly on morphological factors and the use of balloon-assisted techniques. The recanalization rate at mid-term depends on the size of the aneurysm and probably on the density of the packing achieved with the initial treatment.

  • Aneurysm
  • MRI
  • Magnetic Resonance Angiography
  • Subarachnoid

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