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Risk factor analysis of recanalization and retreatment for patients with endovascular treatment of internal carotid artery bifurcation aneurysms

Neuroradiology volume 60, pages 535–544 (2018)Cite this article

Abstract

Purpose

Only a few reports of internal carotid artery (ICA) bifurcation aneurysms using the endovascular technique have been published in the current literature. The purpose of this study was to assess how multiple risk factors including angioarchitectural features of ICA bifurcation characteristics may have influenced aneurysmal rupture, recanalization, and retreatment.

Methods

Fifty-one patients with 52 ICA bifurcation aneurysms treated with endovascular coiling between July 2003 and July 2015 were retrospectively analyzed. The patients’ clinical records, endovascular reports, and clinical and angiographic outcomes were reviewed. We also evaluated risk factors for recanalization and retreatment, including the angioarchitectural anatomy.

Results

The clinical outcomes were observed to be satisfactory in 49 patients (96.0%) and unfavorable in 2 patients (4.0%). The risk factor for aneurysmal rupture was young age (P = 0.024). Symptomatic complications due to thromboembolism occurred in 1.9% of cases; no patients suffered a fatal complication. Eleven of 52 ICA bifurcation aneurysms (21.2%) were recanalized within an average of 54.3 ± 33.5 months of follow-up. Among the aneurysms, 4 (7.7%) underwent recoiling. Multivariate analysis showed that ruptured aneurysms (P = 0.006) and a lower packing density (P = 0.048) were risk factors for recanalization. A lower packing density was the only risk factor for retreatment (P = 0.019).

Conclusion

Endovascular treatment of ICA bifurcation aneurysms is considered safe and acceptable. This study showed that the ICA bifurcation aneurysms ruptured more frequently at a younger age. A higher packing density has been shown to reduce major recanalization and retreatment.

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Fig. 1
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Abbreviations

ACA:

Anterior cerebral artery

CFD:

Computational fluid dynamics

DSA:

Digital subtraction angiography

HTPR:

High on-treatment platelet reactivity

ICA:

Internal carotid artery

mRS:

Modified Rankin Scale

PRU:

P2Y12 reaction units

SAC:

Stent-assisted coiling

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Seung Pil Ban, Hyoung Soo Byoun, Si Un Lee, Tackeun Kim, Jae Seung Bang, Chang Wan Oh & O-Ki Kwon

  2. Department of Neurosurgery, Hallym University Hangang Sacred Heart Hospital, Seoul, South Korea

    Gyojun Hwang

  3. Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, South Korea

    Chang Hyeun Kim

Authors
  1. Seung Pil Ban
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  2. Gyojun Hwang
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  4. Hyoung Soo Byoun
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Correspondence to O-Ki Kwon.

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No funding was received for this study.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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Ban, S.P., Hwang, G., Kim, C.H. et al. Risk factor analysis of recanalization and retreatment for patients with endovascular treatment of internal carotid artery bifurcation aneurysms. Neuroradiology 60, 535–544 (2018). https://doi.org/10.1007/s00234-018-2013-5

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  • DOI: https://doi.org/10.1007/s00234-018-2013-5

Keywords

  • Coil embolization
  • Internal carotid artery bifurcation
  • Recanalization
  • Intracranial aneurysm