Elsevier

Surgical Neurology

Volume 68, Issue 1, July 2007, Pages 19-23
Surgical Neurology

Aneurysm
Comparison of ruptured vs unruptured aneurysms in recanalization after coil embolization

https://doi.org/10.1016/j.surneu.2006.10.021Get rights and content

Abstract

Background

Aneurysm recanalization is a significant problem in coil-treated intracranial aneurysms. We hypothesize ruptured aneurysms are more likely to demonstrate this phenomenon than unruptured aneurysms.

Methods

This was a retrospective study over 4 years. Initial and follow-up angiography results were reviewed and aneurysm obliteration was classified: I, complete; II, residual neck; III, residual aneurysm; and IV, partial treatment. Recanalization was classified as significant, mild, and none.

Results

Two hundred twelve 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 (64.4%) aneurysms (44 ruptured, 72 unruptured). Mean angiographic follow-up was 20 months. Recanalization was significant in 16 (13.8%) aneurysms, mild in 23 (19.8%), and absent in 87 (75%). Sixteen aneurysms underwent recoiling. Factors significant for recanalization by univariate analysis were ruptured vs unruptured (53.5% vs 22.5%; P = .001), larger aneurysm size (t test, P < .0001; median, 8-mm cut point, P < .01), aneurysm location (basilar tip and ICA terminus, P < .05), posterior circulation (P < .05), and younger age (t test, P < .05), whereas aneurysm neck size (4 mm) demonstrated a trend (P = .09). Incomplete initial aneurysm obliteration (II-IV, 20.6% vs I, 4.3%; P < .05) was associated with significant recanalization. In multivariate analysis, younger age (age <52 years; OR, 2.4; 95% CI, 0.194-2.08), ruptured aneurysm (OR, 3.2; 95% CI, 1.25-8.13), and larger aneurysm size (OR, 1.14; 95% CI, 1.04-1.24 linearly; OR, 3.5; 95% CI, 1.38-8.72) significantly predicted aneurysm recanalization. Performance of recoiling was significant with larger aneurysm size (OR, 2.0; 95% CI, 0.02-3.25) and younger age (age <52, OR, 2.4; 95% CI, 0.34-3.31) by multivariate analysis, whereas ruptured aneurysm demonstrated a trend.

Conclusions

In multivariate analyses, ruptured aneurysms, larger aneurysms, and younger patient age were significantly associated with recanalization. Larger aneurysms and younger age were significantly associated with recoiling.

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.

References (14)

  • G. Bavinzski et al.

    Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils

    J Neurosurg

    (1999)
  • J.V. Byrne et al.

    Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding

    J Neurosurg

    (1999)
  • C. Cognard et al.

    Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils

    Radiology

    (1999)
  • D. Fiorella et al.

    Durability of aneurysm embolization with matrix detachable coils

    Neurosurgery

    (2006)
  • S. Gallas et al.

    A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils

    AJNR Am J Neuroradiol

    (2005)
  • M. Hayakawa et al.

    Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system

    J Neurosurg

    (2000)
  • B.L. Hoh et al.

    Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team

    Neurosurgery

    (2004)
There are more references available in the full text version of this article.

Cited by (86)

  • Determination of Aneurysm Volume Critical for Stability After Coil Embolization: A Retrospective Study of 3530 Aneurysms

    2019, World Neurosurgery
    Citation Excerpt :

    Ruptured aneurysm has been associated with recanalization of the coiled aneurysm. Nguyen et al.25 reported that ruptured aneurysms (ruptured vs. unruptured: 53.5% vs. 22.5%) were significantly associated with recanalization. Lv et al.26 also revealed that rupture status predicted recurrence after stent-assisted coil embolization of paraclinoid aneurysms.

  • Surgical Treatment of Recurrent Previously Coiled and/or Stent-Coiled Intracerebral Aneurysms: A Single-Center Experience in a Series of 75 Patients

    2019, World Neurosurgery
    Citation Excerpt :

    Recently, Daou et al.11 reported that an aneurysm size >7 mm was the only predictor of aneurysm recurrence. Similarly, Nguyen et al.12 reported that aneurysm sizes of >8 mm were associated with increased recurrence rates among other factors. Aneurysm locations in the basilar apex, internal carotid artery terminus, and posterior circulation, ruptured aneurysms, and age younger than 52 years were other factors implicated in aneurysm recanalization.

View all citing articles on Scopus
View full text