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Original research
Rebleeding and bleeding in the year following intracranial aneurysm coiling: analysis of a large prospective multicenter cohort of 1140 patients—Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study
  1. Laurent Pierot1,
  2. Coralie Barbe2,
  3. Denis Herbreteau3,
  4. Jean-Yves Gauvrit4,
  5. Anne-Christine Januel5,
  6. Fouzi Bala6,
  7. Frédéric Ricolfi7,
  8. Hubert Desal8,
  9. Stéphane Velasco9,
  10. Mohamed Aggour10,
  11. Emmanuel Chabert11,
  12. Jacques Sedat12,
  13. Denis Trystram13,
  14. Gaultier Marnat14,
  15. Sophie Gallas15,
  16. Georges Rodesch16,
  17. Frédéric Clarençon17,
  18. Chrysanthi Papagiannaki18,
  19. Phil White19,20,
  20. Laurent Spelle21
  1. 1 Radiology, CHU Reims, Reims, Champagne-Ardenne, France
  2. 2 Department of Research and Public Health, CHU Reims, Reims, Champagne-Ardenne, France
  3. 3 Neuroradiology, CHRU Tours, Tours, Centre, France
  4. 4 Neuroradiology, CHU Rennes, Rennes, Bretagne, France
  5. 5 Neuroradiology, CHU Toulouse, Toulouse, Midi-Pyrénées, France
  6. 6 Interventional neuroradiology, CHRU Lille Pôle Spécialités Médicochirurgicales, Lille, Hauts-de-France, France
  7. 7 Neuroradiology, CHU Dijon, Dijon, Bourgogne, France
  8. 8 Neuroradiology, CHU Nantes, Nantes, Pays de la Loire, France
  9. 9 Radiology, CHU Poitiers, Poitiers, France
  10. 10 Neuroradiology, CHU Saint-Étienne, Saint-Etienne, Rhône-Alpes, France
  11. 11 Neuroradiologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
  12. 12 Neurointerventionnel, CHU Nice, Nice, Provence-Alpes-Côte d'Azu, France
  13. 13 neuroradiology, CH Sainte Anne, Paris, Île-de-France, France
  14. 14 Interventional and Diagnostic Neuroradiology, CHU de Bordeaux, Bordeaux, Aquitaine, France
  15. 15 Neuroradiology, CHU Bicêtre, Le Kremlin-Bicetre, Île-de-France, France
  16. 16 Neuroradiology, Hopital Foch, Suresnes, Île-de-France, France
  17. 17 Neuroradiology, IFR des Neurosciences CHU Pitie-Salpetriere IFR 70, Paris, Île-de-France, France
  18. 18 Interventional Neuroradiology, CHU Rouen, Rouen, Normandie, France
  19. 19 Institute for Ageing & Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  20. 20 Neuroradiology, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
  21. 21 Interventional Neuroradiology, CHU Bicêtre, Le Kremlin-Bicetre, Île-de-France, France
  1. Correspondence to Dr Laurent Pierot, Radiology, CHU Reims, Reims, Champagne-Ardenne, France; lpierot{at}


Background Endovascular treatment is the first line therapy for the management of ruptured and unruptured intracranial aneurysms, but delayed aneurysm rupture leading to bleeding/rebleeding can occur subsequently. ARETA (Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm) is a prospective, multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed bleeding and rebleeding in this large cohort.

Methods 16 neurointerventional departments prospectively enrolled patients treated for ruptured and unruptured aneurysms between December 2013 and May 2015 ( NCT01942512). Participant demographics, aneurysm characteristics and endovascular techniques were recorded. Data were analyzed from participants with ruptured or unruptured aneurysms treated by coiling or balloon-assisted coiling. Rates of bleeding and rebleeding were analyzed and associated factors were studied using univariable and multivariable analyses.

Results The bleeding rate was 0.0% in patients with unruptured aneurysms and 1.0% (95% CI 0.3% to 1.7%) in patients with ruptured aneurysms. In multivariate analysis, two factors were associated with rebleeding occurrence: incomplete aneurysm occlusion after initial treatment (2.0% in incomplete aneurysm occlusion vs 0.2% in complete aneurysm occlusion, OR 10.2, 95% CI 1.2 to 83.3; p=0.03) and dome-to-neck ratio (1.5±0.5 with rebleeding vs 2.2±0.9 without rebleeding, OR 0.2, 95% CI 0.04 to 0.8; p=0.03). Modalities of management of aneurysm rebleeding as well as clinical outcomes are described.

Conclusions Aneurysm coiling affords good protection against bleeding (for unruptured aneurysms) and rebleeding (for ruptured aneurysms) at 1 year with rates of 0.0% and 1.0%, respectively. Aneurysm occlusion and dome-to-neck ratio are the two factors that appear to play a role in the occurrence of rebleeding.

  • aneurysm
  • coil
  • hemorrhage
  • neck

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  • Contributors All authors have: provided a substantial contribution to the conception and design of the studies and/or the acquisition and/or the analysis of the data and/or the interpretation of the data; drafted the work or revised it for significant intellectual content; approved the final version of the manuscript; agreed to be accountable for all aspects of the work, including its accuracy and integrity.

  • Funding The French Health Ministry has funded ARETA (Programme Hospitalier de Recherche Clinique, No. 12-001-0372).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data related to this manuscript are available upon reasonable request.