RT Journal Article
SR Electronic
T1 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
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1219
OP 1225
DO 10.1136/neurintsurg-2020-015971
VO 12
IS 12
A1 Pierot, Laurent
A1 Barbe, Coralie
A1 Herbreteau, Denis
A1 Gauvrit, Jean-Yves
A1 Januel, Anne-Christine
A1 Bala, Fouzi
A1 Ricolfi, Frédéric
A1 Desal, Hubert
A1 Velasco, Stéphane
A1 Aggour, Mohamed
A1 Chabert, Emmanuel
A1 Sedat, Jacques
A1 Trystram, Denis
A1 Marnat, Gaultier
A1 Gallas, Sophie
A1 Rodesch, Georges
A1 Clarençon, Frédéric
A1 Papagiannaki, Chrysanthi
A1 White, Phil
A1 Spelle, Laurent
YR 2020
UL http://jnis.bmj.com/content/12/12/1219.abstract
AB 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 (ClinicalTrials.gov: 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.