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Abstract
Background and Purpose Double catheter coil embolisation (DCC) technique has been used for the treatment of wide neck aneurysms. Unlike Stent assisted Coil Embolisation (SAC), DCC does not require long term post-treatment anti-platelet therapy. Whether or not DCC can reduce the procedure related complications in SAC is not clear. In this series, consecutive unruptured wide neck aneurysm patients were treated primarily with the DCC. SAC was only used as a rescue therapy when the coil mass in the aneurysm was considered to be unstable. Clinical as well as angiographical outcomes of those who treated with DCC were reviewed.
Methods A total of 597 unruptured aneurysm patients were treated in our institution between 2006 and 2012. Of these, 144 patients with wide neck (neck size >4.0 or dome-neck ratio<2.0) saccular aneurysm were primarily treated with DCC. Dual antiplatelet therapy was initiated 3 days prior to the procedure. If the treatment was completed with DCC, single antiplatelet therapy was continued for one month and then discontinued. Follow up MRI was performed at 3,6, and 12 months after the treatment. An angiogram was performed at 1 year, and the surveillance MRIs with every 6 to 12 months were continued.
Results A total of 129 patients were treated with DCC only, and 5 patients were shifted to the SAC based on the intra-procedural findings. The average neck size and the average dome-neck ratio of the treated aneurysms were 6mm and 1.3 respectively. Every aneurysm treated with DCC was successfully embolised. Intra-operative hemorrhagic event occurred in 2 cases. There was no intra-operative thrombo-embolic event. During the average follow up period of 809 days, post operative symptomatic ischaemic events were seen in two cases (1.6%) and post operative hemorrhagic event (procedure unrelated) was seen in 1 case (0.8%). Permanent morbidity and mortality throughout was 2.4% and 0.8% respectively. Recanalisation that required re-treatment was seen in 14.7% but there was no procedure related complication during the re-treatment.
Conclusion The angiographic outcomes of the aneurysms treated with DCC in this series were comparable to the historical controls of the wide neck aneurysms treated with other adjunctive techniques. To minimise procedure related ischaemic/haemorrhagic event associated with the SAC, DCC may be a potential candidate of alternative treatment.
Disclosures I. Yuki: None. T. Ishibashi: None. H. Arakawa: None. K. Irie: None. H. Takao: None. I. Kajiwara: None. K. Misaki: None. K. Nishimura: None. A. Ikemura: None. T. Abe: None. Y. Murayama: None.