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Original research
Immediate post-operative aneurysm occlusion after endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1189 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
  21. From the Departments of Neuroradiology, Research, and Public Health
  1. 1Neuroradiology, CHU Reims, Reims, Champagne-Ardenne, France
  2. 2Department of Research and Public Health, Centre Hospitalier Universitaire de Reims, Reims, Champagne-Ardenne, France
  3. 3Interventional Neuroradiology, CHU Tours, Tours, France
  4. 4Neuroradiology, CHU Rennes, Rennes, Bretagne, France
  5. 5Neuroradiology, CHU Toulouse, Toulouse, Midi-Pyrénées, France
  6. 6Interventional Neuroradiology, CHU Lille, Lille, Hauts-de-France, France
  7. 7Neuroradiology, CHU Dijon, Dijon, Bourgogne, France
  8. 8Neuroradiology, CHU Nantes, Nantes, Pays de la Loire, France
  9. 9Radiology, CHU Poitiers, Poitiers, France
  10. 10Interventional Neuroardiology, CHUSaint-Etienne, Saint-Etienne, France
  11. 11Neuroradiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
  12. 12Neurointerventionnel, CHU Nice, Nice, Provence-Alpes-Côte d'Azu, France
  13. 13Neuroradiology, Centre Hospitalier Sainte Anne, Paris, Île-de-France, France
  14. 14Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
  15. 15Interventional Neuroradiology, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
  16. 16Neuroradiology, Hôpital Foch, Suresnes, Île-de-France, France
  17. 17Neuroradiology, APHP, Paris, Île-de-France, France
  18. 18Interventional Neuroradiology, CHU Rouen, Rouen, Normandie, France
  19. 19Institute for Ageing & Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  20. 20Neuroradiology, Newcastle upon Tyne, UK
  21. 21Interventional Neuroradiology, APHP, Paris, Île-de-France, France
  1. Correspondence to Dr Laurent Pierot, Neuroradiology, CHU Reims, Reims 51100, France; lpierot{at}gmail.com

Abstract

Background Coiling, including balloon-assisted coiling (BAC), is the first-line therapy for ruptured and unruptured aneurysms. Its efficacy can be clinically evaluated by bleeding/rebleeding rate after coiling, and anatomically evaluated by aneurysm occlusion post-procedure and during follow-up. We aimed to analyze immediate post-coiling aneurysm occlusion and associated factors within the Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) population.

Methods Between December 2013 and May 2015, 16 neurointerventional departments prospectively enrolled participants treated for ruptured and unruptured aneurysms (ClinicalTrials.gov: NCT01942512). Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. In patients with aneurysms treated by coiling or BAC, immediate post-operative aneurysm occlusion was independently evaluated by a core lab using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant.

Results Of 1135 participants (age 53.8±12.8 years, 754 women (66.4%)), 1189 aneurysms were analyzed. Treatment modality was standard coiling in 645/1189 aneurysms (54.2%) and BAC in 544/1189 (45.8%). Immediate post-operative aneurysm occlusion was complete occlusion in 57.8%, neck remnant in 34.4%, and aneurysm remnant in 7.8%. Adequate occlusion (complete occlusion or neck remnant) was significantly more frequent in aneurysms with size <10 mm (93.1% vs 86.3%; OR 1.8, 95% CI 1.1 to 3.2; p=0.02) and in aneurysms with a narrow neck (95.8% vs 89.6%; OR 2.5, 95% CI 1.5 to 4.1; p=0.0004). Patients aged <70 years had significantly more adequate occlusion (92.7% vs 87.2%; OR 1.9, 95% CI 1.1 to 3.4; p=0.04).

Conclusions Immediately after aneurysm coiling, including BAC, adequate aneurysm occlusion was obtained in 92.2%. Age <70 years, aneurysm size <10 mm, and narrow neck were factors associated with adequate occlusion.

Trial registration number NCT01942512, http://www.clinicaltrials.gov.

  • aneurysm
  • coil
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Footnotes

  • 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; and 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 Data are available upon reasonable request. Data analyzed during the study are available from the corresponding author by request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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