AneurysmComparison of ruptured vs unruptured aneurysms in recanalization after coil embolization
Introduction
Endovascular therapy has emerged as a successful treatment for cerebral aneurysms in properly selected individuals, yet the long-term efficacy and durability of coil treatment remains in question. Compared to surgical clipping, aneurysm recanalization occurs more frequently after coil therapy and has been reported in 17% to 42% of small and 57% to 90% of large aneurysms [1], [2], [3], [4], [5], [6], [8], [9], [10], [11], [13].
Identification of factors thought to be associated with recanalization would be helpful in targeting a subpopulation at risk for aneurysmal recurrence and, hence, rigorous angiographic follow-up. The goal of the study was to determine whether ruptured vs unruptured aneurysms have different risks of aneurysm recanalization.
Section snippets
Patient population
We retrospectively reviewed the angiograms and medical records of consecutive patients older than 18 years with intracranial aneurysms who underwent endovascular treatment from February 1998 to June 2002. Clinical features examined included ruptured vs unruptured aneurysm, age, sex, aneurysm size, aneurysm neck size, location, degree of obliteration, and year of procedure.
Embolization procedure
Our technique and procedure, using a biplane C-arm angiographic system with 3-dimensional reconstruction for endovascular
Results
Over the 4-year period, 212 aneurysms were coiled in 199 patients, of which 180 patients survived to 6 months after treatment. Follow-up angiography (>6 months) was available for 116 aneurysms (64.4%); 44 were ruptured and 72 unruptured. When comparing patients with follow-up angiography vs without follow-up angiography, there was no difference in sex, aneurysm size, location of aneurysm, and degree of initial obliteration; however, there were more ruptured aneurysms in the patients without
Discussion
Our study confirms that ruptured aneurysms have increased risk of aneurysm recanalization after coil embolization compared with unruptured aneurysms. This finding is consistent with that of several studies, including findings in the Raymond et al [11] series where the relative risk of aneurysm recurrence was 1.96 times more likely for a ruptured vs unruptured aneurysm. In the Hope et al [8] series, successful coil embolization was more likely in patients with unruptured compared with ruptured
Conclusions
In multivariate analyses, ruptured aneurysms, larger aneurysms, and younger patient age were significantly associated with aneurysm recanalization, and larger aneurysms and younger patient age were significantly associated with performance of recoiling. This study emphasizes the concept that young patients who have ruptured and larger aneurysms should continue to undergo rigorous follow-up, as they are at higher risk for aneurysm recanalization. The study also raises the question of whether
Acknowledgments
The authors thank Joshua A. Hirsch, MD, James D. Rabinov, MD, Christopher M. Putman, MD, and Ronald F. Budzik, MD.
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