Skip to main content

Advertisement

SpringerLink
Log in

Endovascular Treatment of Intracranial Aneurysms: Long-Term Stability, Risk Factors for Recurrences, Retreatment and Follow-Up*

Endovaskuläre Behandlung intrakranieller Aneurysmen: Langzeitstabilität, Risikofaktoren für eine Rezidiventstehung, Rezidivbehandlung und Nachkontrollen

  • Review Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

It is accepted that endovascular treatment for intracranial aneurysms < 2 cm in diameter is not an alternative option to surgical treatment anymore but has rather gained the place as the first therapeutic option. Still, the long-term efficacy of endovascular aneurysm treatment remains uncertain. This article discusses clinical significance, incidence, risk factors and current management of aneurysm recurrence after endovascular treatment of intracranial aneurysms based on own Hamburg data and review of the literature. It also attempts to address potential solutions and future avenues to improve long-term efficacy of endovascularly treated intracranial aneurysms.

Zusammenfassung

Die endovaskuläre Therapie intrakranieller Aneurysmen, deren Durchmesser < 2 cm liegt, ist nicht mehr nur eine Alternative zur neurochirurgischen Operation, sondern zur Therapieoption der ersten Wahl geworden. Wie sicher und effizient eine endovaskuläre Behandlung intrakranieller Aneurysmen im langfristigen Verlauf eine Aneurysmablutung verhindert, muss weiterhin evaluiert werden. Dieser Artikel diskutiert die klinische Relevanz, die Inzidenz, Risikofaktoren und das derzeitige Management von Aneurysmarezidiven nach endovaskulärer Therapie, basierend auf eigenen Hamburger Daten und Literaturdaten. Des Weiteren sollen derzeitige und zukünftige Lösungsansätze zur Verbesserung der Langzeitstabilität endovaskulär versorgter intrakranieller Aneurysmen beleuchtet werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Qureshi AI, Janardhan V, Hanel RA, Lanzino G. Comparison of endovascular and surgical treatments for intracranial aneurysms: an evidencebased review. Lancet Neurol 2007;6:816–25.

    Article  PubMed  Google Scholar 

  2. Hopkins LN, Lanzino G, Guterman LR. Treating complex nervous system vascular disorders through a "needle stick": origins, evolution, and future of neuroendovascular therapy. Neurosurgery 2001;48:463–75.

    Article  PubMed  CAS  Google Scholar 

  3. Fingerhut AG, Alksne JF. Thrombosis of intracranial aneurysms. An experimental approach utilizing magnetically controlled iron particles. Radiology 1966;86:342–3.

    PubMed  CAS  Google Scholar 

  4. Alksne JF, Fingerhut AG. Magnetically controlled metallic thrombosis of intracranial aneurysms. A preliminary report. Bull Los Angeles Neurol Soc 1965;30:153–5.

    PubMed  CAS  Google Scholar 

  5. Serbinenko F. Balloon occlusion of saccular aneurysms of the cerebral arteries. Vopr Neirokhir 1974;4:8–15.

    PubMed  Google Scholar 

  6. Guglielmi G, Vinuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 1991;75:8–14.

    PubMed  CAS  Google Scholar 

  7. Guglielmi G, Vinuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 1991;75:1–7.

    Article  PubMed  CAS  Google Scholar 

  8. Koebbe CJ, Veznedaroglu E, Jabbour P, Rosenwasser RH. Endovascular management of intracranial aneurysms: current experience and future advances. Neurosurgery 2006;59:Suppl 5:S93–102, discussion S103–13.

    Article  PubMed  Google Scholar 

  9. Friedman JA, Nichols DA, Meyer FB, Pichelmann MA, McIver JI, Toussaint LG 3rd, Axley PL, Brown RD Jr. Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. AJNR Am J Neuroradiol 2003;24:526–33.

    PubMed  Google Scholar 

  10. Gallas S, Pasco A, Cottier JP, Gabrillargues J, Drouineau J, Cognard C, Herbreteau D. A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 2005;26:1723–31.

    PubMed  Google Scholar 

  11. Henkes H, Fischer S, Weber W, Miloslavski E, Felber S, Brew S, Kuehne D. Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 2004;54:268–80, discussion 280–65.

    Article  PubMed  Google Scholar 

  12. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267–74.

    Article  PubMed  Google Scholar 

  13. Molyneux A, Kerr R, Yu L, Clarke M, Sneade M, Yarnold J, Sandercock P, Group ISATIC. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005;366:809–17.

    Article  PubMed  Google Scholar 

  14. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Vinuela F. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 2003;98:959–66.

    Article  PubMed  Google Scholar 

  15. Solymosi L, Chapot R, Bendszus M. Stent, balloon, or clip? The problem of wide-necked aneurysms. Klin Neuroradiol 2005;15:145–60.

    Article  Google Scholar 

  16. Van Rooij WJ, Sluzewski M. Procedural morbidity and mortality of elective coil treatment of unruptured intracranial aneurysms. AJNR Am J Neuroradiol 2006;27:1678–80.

    PubMed  CAS  Google Scholar 

  17. Johnston SC, Dudley RA, Gress DR, Ono L. Surgical and endovascular treatment of unruptured cerebral aneurysms at university hospitals. Neurology 1999;52:1799–805.

    PubMed  CAS  Google Scholar 

  18. Johnston SC, Wilson CB, Halbach VV, Higashida RT, Dowd CF, McDermott MW, Applebury CB, Farley TL, Gress DR. Endovascular and surgical treatment of unruptured cerebral aneurysms: comparison of risks. Ann Neurol 2000;48:11–9.

    Article  PubMed  CAS  Google Scholar 

  19. Johnston SC, Zhao S, Dudley RA, Berman MF, Gress DR. Treatment of unruptured cerebral aneurysms in California. Stroke 2001;32:597–605.

    Article  PubMed  CAS  Google Scholar 

  20. Boet R, Wong G, Poon W, Lam J, Yu S. Aneurysm recurrence after treatment of paraclinoid/ophthalmic segment aneurysms – a treatmentmodality assessment. Acta Neurochir (Wien) 2005;147:611–6.

    Article  CAS  Google Scholar 

  21. Campi A, Summers P, Molyneux A, Byrne J. Why aneurysms needed retreatment in ISAT. Neuroradiology 2006;48:Suppl 2:S57–135.

    Article  Google Scholar 

  22. Sluzewski M, van Rooij WJ, Rinkel GJ, Wijnalda D. Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology 2003;227:720–4.

    Article  PubMed  Google Scholar 

  23. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398–403.

    Article  PubMed  Google Scholar 

  24. Kang H, Han M, Kwon B, Kwon O, Kim S. Repeat endovascular treatment in post-embolization recurrent intracranial aneurysms. Neurosurgery 2006;58:60–70.

    Article  PubMed  Google Scholar 

  25. Henkes H, Fischer S, Liebig T, Weber W, Reinartz J, Miloslavski E, Kuhne D. Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery 2006;58:224–32.

    Article  PubMed  Google Scholar 

  26. Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 2007;38:1538–44.

    Article  PubMed  Google Scholar 

  27. Ries T, Siemonsen S, Thomalla G, Grzyska U, Zeumer H, Fiehler J. Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. AJNR Am J Neuroradiol 2007;28:1755–61.

    Article  PubMed  CAS  Google Scholar 

  28. CARAT Investigators. Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke 2006;37:1437–42.

  29. Sluzewski M, van Rooij WJ. Early rebleeding after coiling of ruptured cerebral aneurysms: incidence, morbidity, and risk factors. AJNR Am J Neuroradiol 2005;26:1739–43.

    PubMed  Google Scholar 

  30. Hayakawa M, Murayama Y, Duckwiler G, Gobin Y, Guglielmi G, Vinuela F. Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 2000;93:561–8.

    Article  PubMed  CAS  Google Scholar 

  31. Byrne JV, Sohn MJ, Molyneux AJ, Chir B. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg 1999;90:656–63.

    Article  PubMed  CAS  Google Scholar 

  32. Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 2008;39:120–5.

    Article  PubMed  Google Scholar 

  33. Slob MJ, Sluzewski M, van Rooij WJ, Roks G, Rinkel GJ. Additional coiling of previously coiled cerebral aneurysms: clinical and angiographic results. AJNR Am J Neuroradiol 2004;25:1373–6.

    PubMed  Google Scholar 

  34. Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke 2001;32:1998–2004.

    Article  PubMed  CAS  Google Scholar 

  35. Van Rooij WJ, Sprengers ME, Sluzewski M, Beute GN. Intracranial aneurysms that repeatedly reopen over time after coiling: imaging characteristics and treatment outcome. Neuroradiology 2007;49:343–9.

    Article  PubMed  Google Scholar 

  36. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 1999;212:348–56.

    PubMed  CAS  Google Scholar 

  37. Grzyska U, Freitag J, Zeumer H. Selective cerebral intraarterial DSA. Complication rate and control of risk factors. Neuroradiology 1990;32:296–9.

    Article  PubMed  CAS  Google Scholar 

  38. Heiserman JE, Dean BL, Hodak JA, Flom RA, Bird CR, Drayer BP, Fram EK. Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol 1994;15:1401–7, discussion 1408–11.

    PubMed  CAS  Google Scholar 

  39. Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 2003;227:522–8.

    Article  PubMed  Google Scholar 

  40. Kwee TC, Kwee RM. MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils: systematic review and meta-analysis. Neuroradiology 2007;49:703–13.

    Article  PubMed  Google Scholar 

  41. Yamada N, Hayashi K, Murao K, Higashi M, Iihara K. Time-of-flight MR angiography targeted to coiled intracranial aneurysms is more sensitive to residual flow than is digital subtraction angiography. AJNR Am J Neuroradiol 2004;25:1154–7.

    PubMed  Google Scholar 

  42. Buhk JH, Kallenberg K, Mohr A, Dechent P, Knauth M. No advantage of time-of-flight magnetic resonance angiography at 3 Tesla compared to 1.5 Tesla in the follow-up after endovascular treatment of cerebral aneurysms. Neuroradiology 2008;50:855–61.

    Article  PubMed  Google Scholar 

  43. Cottier JP, Bleuzen-Couthon A, Gallas S, Vinikoff-Sonier CB, Bertrand P, Domengie F, Barantin L, Herbreteau D. Intracranial aneurysms treated with Guglielmi detachable coils: is contrast material necessary in the follow-up with 3-D time-of-flight MR angiography? AJNR Am J Neuroradiol 2003;24:1797–803.

    PubMed  Google Scholar 

  44. Leclerc X, Navez JF, Gauvrit JY, Lejeune JP, Pruvo JP. Aneurysms of the anterior communicating artery treated with Guglielmi detachable coils: follow-up with contrast-enhanced MR angiography. AJNR Am J Neuroradiol 2002;23:1121–7.

    PubMed  Google Scholar 

  45. Farb RI, Nag S, Scott JN, Willinsky RA, Marotta TR, Montanera WJ, Tomlinson G, Terbrugge KG. Surveillance of intracranial aneurysms treated with detachable coils: a comparison of MRA techniques. Neuroradiology 2005;47:507–15.

    Article  PubMed  Google Scholar 

  46. Pierot L, Delcourt C, Bouquigny F, Breidt D, Feuillet B, Lanoix O, Gallas S. Follow-up of intracranial aneurysms selectively treated with coils: Prospective evaluation of contrast-enhanced MR angiography. AJNR Am J Neuroradiol 2006;27:744–9.

    PubMed  CAS  Google Scholar 

  47. Tamatani S, Ito Y, Abe H, Koike T, Takeuchi S, Tanaka R. Evaluation of the stability of aneurysms after embolization using detachable coils: correlation between stability of aneurysms and embolized volume of aneurysms. AJNR Am J Neuroradiol 2002;23:762–7.

    PubMed  Google Scholar 

  48. Sluzewski M, van Rooij WJ, Beute GN, Nijssen PC. Late rebleeding of ruptured intracranial aneurysms treated with detachable coils. AJNR Am J Neuroradiol 2005;26:2542–9.

    PubMed  Google Scholar 

  49. Thornton J, Debrun GM, Aletich VA, Bashir Q, Charbel FT, Ausman J. Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 2002;50:239–49, discussion 249–50.

    Article  PubMed  Google Scholar 

  50. Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W. Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke 2002;33:210–7.

    Article  PubMed  CAS  Google Scholar 

  51. Groden C, Eckert B, Ries T, Probst EN, Kucinski T, Zeumer H. Angiographic follow-up of vertebrobasilar artery aneurysms treated with detachable coils. Neuroradiology 2003;45:435–40.

    Article  PubMed  CAS  Google Scholar 

  52. Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, Kassam A. Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2005;26:506–14.

    PubMed  Google Scholar 

  53. Renowden SA, Koumellis P, Benes V, Mukonoweshuro W, Molyneux AJ, McConachie NS. Retreatment of previously embolized cerebral aneurysms: the risk of further coil embolization does not negate the advantage of the initial embolization. AJNR Am J Neuroradiol 2008;29:1401–4.

    Article  PubMed  CAS  Google Scholar 

  54. Sluzewski M, Bosch JA, van Rooij WJ, Nijssen PC, Wijnalda D. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors. J Neurosurg 2001;94:238–40.

    Article  PubMed  CAS  Google Scholar 

  55. Cloft HJ, Kallmes DF. Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. AJNR Am J Neuroradiol 2002;23:1706–9.

    PubMed  Google Scholar 

  56. Ries T, Buhk J, Kucinski T, Goebell E, Grzyska U, Zeumer H, Fiehler J. Intravenous administration of acetylsalicylic acid during endovascular treatment of cerebral aneurysms reduces the rate of thromboembolic events. Stroke 2006;37:1816–21.

    Article  PubMed  CAS  Google Scholar 

  57. Mitchell P, Kerr R, Mendelow AD, Molyneux A. Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the International Subarachnoid Aneurysm Trial? J Neurosurg 2008;108:437–42.

    Article  PubMed  Google Scholar 

  58. Koffijberg H, Buskens E, Algra A, Wermer MJ, Rinkel GJ. Growth rates of intracranial aneurysms: exploring constancy. J Neurosurg 2008;109:176–85.

    Article  PubMed  Google Scholar 

  59. Vallee JN, Pierot L, Bonafe A, Turjman F, Flandroy P, Berge J, Rodesch G, Bracard S. Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils: predictors of immediate anatomic and clinical results. AJNR Am J Neuroradiol 2004;25:298–306.

    PubMed  Google Scholar 

  60. Raymond J, Leblanc P, Lambert A, Georganos SA, Guilbert F, Janicki C, Roorda S. Feasibility of radioactive embolization of intracranial aneurysms using 32P-implanted coils. Stroke 2003;34:1035–7.

    Article  PubMed  Google Scholar 

  61. Pierot L, Leclerc X, Bonafe A, Bracard S. Endovascular treatment of intracranial aneurysms with matrix detachable coils: midterm anatomic follow-up from a prospective multicenter registry. AJNR Am J Neuroradiol 2008;29:57–61.

    Article  PubMed  CAS  Google Scholar 

  62. Cloft HJ. HydroCoil for Endovascular Aneurysm Occlusion (HEAL) study: periprocedural results. AJNR Am J Neuroradiol 2006;27:289–92.

    PubMed  CAS  Google Scholar 

  63. Sluzewski M, van Rooij W, Beute G, Nijssen P. Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results. J Neurosurg 2006;105:396–9.

    Article  PubMed  Google Scholar 

  64. Van Rooij WJ, Sluzewski M, Beute GN, Nijssen PC. Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 2006;27:1498–501.

    PubMed  CAS  Google Scholar 

  65. Lubicz B, Lefranc F, Bruneau M, Baleriaux D, Witte OD. Balloon-assisted coiling of intracranial aneurysms is not associated with a higher complication rate. Neuroradiology 2008;50:769–76.

    Article  PubMed  Google Scholar 

  66. Soeda A, Sakai N, Sakai H, Iihara K, Yamada N, Imakita S, Nagata I. Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2003;24:127–32.

    PubMed  Google Scholar 

  67. Layton KF, Cloft HJ, Gray LA, Lewis DA, Kallmes DF. Balloon-assisted coiling of intracranial aneurysms: evaluation of local thrombus formation and symptomatic thromboembolic complications. AJNR Am J Neuroradiol 2007;28:1172–5.

    Article  PubMed  CAS  Google Scholar 

  68. Moret J, Cognard C, Weill A, Castaings L, Rey A. Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol 1997;24:30–44.

    PubMed  CAS  Google Scholar 

  69. Biondi A, Janardhan V, Katz JM, Salvaggio K, Riina HA, Gobin YP. Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 2007;61:460–8, discussion 468–9.

    Article  PubMed  Google Scholar 

  70. Ries T, Säring D, Forkert N, Zeumer H, Fiehler J. Visualization and quantification of aneurysm recurrences in rigid 3D-3D-coregistered MRA. German Society of Neuroradiology, Annual Meeting October 29–November 1, 2008; Saarbrücken, Germany.

Download references

Author information

Authors and Affiliations

  1. Department of Neuroradiology, University Hospital Eppendorf, Hamburg, Germany

    Thorsten Ries MD

  2. Department of Neuroradiology, Faculty for Clinical Medicine, University Heidelberg, Mannheim, Germany

    Christoph Groden

  3. Department of Neuroradiology, University Hospital Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Thorsten Ries MD

Authors
  1. Thorsten Ries MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph Groden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thorsten Ries MD.

Additional information

* Dedicated to Professor Hermann Zeumer, MD, on the occasion of his 65th birthday and his retirement.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ries, T., Groden, C. Endovascular Treatment of Intracranial Aneurysms: Long-Term Stability, Risk Factors for Recurrences, Retreatment and Follow-Up*. Clin Neuroradiol 19, 62–72 (2009). https://doi.org/10.1007/s00062-009-8032-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-009-8032-1

Key Words:

Schlüsselwörter:

Search

Navigation