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.
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.
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).
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Anterior cerebral artery
Computational fluid dynamics
Digital subtraction angiography
High on-treatment platelet reactivity
Internal carotid artery
Modified Rankin Scale
P2Y12 reaction units
Konczalla J, Platz J, Brawanski N, Guresir E, Lescher S, Senft C, du Mesnil De Rochemont R, Berkefeld J, Seifert V (2015) Endovascular and surgical treatment of internal carotid bifurcation aneurysms: comparison of results, outcome, and mid-term follow-up. Neurosurgery 76:540–550
Lee WJ, Cho YD, Kang HS, Kim JE, Cho WS, Kim KM, Han MH (2014) Endovascular coil embolization in internal carotid artery bifurcation aneurysms. Clin Radiol 69:e273–e279
Morales-Valero SF, Brinjikji W, Murad MH, Wald JT, Lanzino G (2014) Endovascular treatment of internal carotid artery bifurcation aneurysms: a single-center experience and a systematic review and meta-analysis. AJNR Am J Neuroradiol 35:1948–1953
Oishi H, Yamamoto M, Nonaka S, Arai H (2013) Endovascular therapy of internal carotid artery bifurcation aneurysms. J Neurointerv Surg 5:400–404
Uemura A, Musacchio M, Cardoso M, Mostoufizadeh S, Tournade A (2008) Internal carotid bifurcation aneurysms: anatomical features and outcome of endovascular treatment. Neuroradiol J 21:574–578
van Rooij WJ, Sluzewski M, Beute GN (2008) Internal carotid bifurcation aneurysms: frequency, angiographic anatomy and results of coiling in 50 aneurysms. Neuroradiology 50:583–587
Ingebrigtsen T, Morgan MK, Faulder K, Ingebrightsen L, Sparr T, Schirmer H (2004) Bifurcation geometry and the presence of cerebral artery aneurysms. J Neurosurg 101:108–113
Li C, Wang S, Chen J, Yu H, Zhang Y, Jiang F, Mu S, Li H, Yang X (2012) Influence of hemodynamics on recanalization of totally occluded intracranial aneurysms: a patient-specific computational fluid dynamic simulation study. J Neurosurg 117:276–283
Ortega J, Hartman J, Rodriguez J, Maitland D (2008) Post-treatment hemodynamics of a basilar aneurysm and bifurcation. Ann Biomed Eng 36:1531–1546
Baharoglu MI, Lauric A, Safain MG, Hippelheuser J, Wu C, Malek AM (2014) Widening and high inclination of the middle cerebral artery bifurcation are associated with presence of aneurysms. Stroke 45:2649–2655
Dhar S, Tremmel M, Mocco J, Kim M, Yamamoto J, Siddiqui AH, Hopkins LN, Meng H (2008) Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 63:185–196
Geyik S, Yavuz K, Cekirge S, Saatci I (2007) Endovascular treatment of basilar and ICA termination aneurysms: effects of the use of HydroCoils on treatment stability in a subgroup of patients prone to a higher recurrence rate. Neuroradiology 49:1015–1021
Ho A, Lin N, Charoenvimolphan N, Stanley M, Frerichs KU, Day AL, Du R (2014) Morphological parameters associated with ruptured posterior communicating aneurysms. PLoS One 9:e94837
Raghavan ML, Ma B, Harbaugh RE (2005) Quantified aneurysm shape and rupture risk. J Neurosurg 102:355–362
Kim CH, Hwang G, Kwon OK, Ban SP, Chinh ND, Tjahjadi M, Oh CW, Bang JS, Kim T (2016) P2Y12 reaction units threshold for implementing modified antiplatelet preparation in coil embolization of unruptured aneurysms: a prospective validation study. Radiology 282:542–551
Hwang G, Huh W, Lee JS, Villavicencio JB, Villamor RB Jr, Ahn SY, Kim J, Chang JY, Park SJ, Park NM, Jeong EA, Kwon OK (2015) Standard vs modified antiplatelet preparation for preventing thromboembolic events in patients with high on-treatment platelet reactivity undergoing coil embolization for an unruptured intracranial aneurysm: a randomized clinical trial. JAMA Neurol 72:764–772
Uyttenboogaart M, Stewart RE, Vroomen PC, De Keyser J, Luijckx GJ (2005) Optimizing cutoff scores for the Barthel index and the modified Rankin Scale for defining outcome in acute stroke trials. Stroke 36:1984–1987
Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403
Ho AL, Mouminah A, Du R (2014) Posterior cerebral artery angle and the rupture of basilar tip aneurysms. PLoS One 9:e110946
van Gijn J, Kerr RS, Rinkel GJ (2007) Subarachnoid haemorrhage. Lancet 369:306–318
Wang GX, Wen L, Zhang YL, QC YJB, Duan CM, Zhang D (2018) Risk factors for the rupture of intracranial aneurysms using computed tomography angiography. World Neurosurg 110:e333-e338
International Study of Unruptured Intracranial Aneurysms Investigators (1998) Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733
Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356
Chalouhi N, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, Starke RM, Gordon D, Hann S, Tjoumakaris S (2012) Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases. Neurosurgery 71:785–794
Cho WS, Hong HS, Kang HS, Kim JE, Cho YD, Kwon OK, Bang JS, Hwang G, Son YJ, Oh CW, Han MH (2015) Stability of cerebral aneurysms after stent-assisted coil embolization: a propensity score-matched analysis. Neurosurgery 77:208–216
Peterson E, Hanak B, Morton R, Osbun JW, Levitt MR, Kim LJ (2014) Are aneurysms treated with balloon-assisted coiling and stent-assisted coiling different? Morphological analysis of 113 unruptured wide-necked aneurysms treated with adjunctive devices. Neurosurgery 75:145–151
Vallee JN, Aymard A, Vicaut E, Reis M, Merland JJ (2003) Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils: predictors of immediate and long-term results with multivariate analysis 6-year experience. Radiology 226:867–879
Ferns SP, Sprengers ME, van Rooij WJ, Rinkel GJ, van Rijn JC, Bipat S, Sluzewski M, Majoie CB (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40:e523–e529
Lecler A, Raymond J, Rodriguez-Régent C, Al Shareef F, Trystram D, Godon-Hardy S, Ben Hassen W, Meder JF, Oppenheim C, Naggara ON (2015) Intracranial aneurysms: recurrences more than 10 years after endovascular treatment—a prospective cohort study, systematic review, and meta-analysis. Radiology 277:173–180
Hassan T, Timofeev EV, Saito T, Shimizu H, Ezura M, Matsumoto Y, Takayama K, Tominaga T, Takahashi A (2005) A proposed parent vessel geometry-based categorization of saccular intracranial aneurysms: computational flow dynamics analysis of the risk factors for lesion rupture. J Neurosurg 103:662–680
Songsaeng D, Geibprasert S, ter Brugge KG, Willinsky R, Tymianski M, Krings T (2011) Impact of individual intracranial arterial aneurysm morphology on initial obliteration and recurrence rates of endovascular treatments: a multivariate analysis. J Neurosurg 114:994–1002
Takeuchi S, Karino T (2010) Flow patterns and distributions of fluid velocity and wall shear stress in the human internal carotid and middle cerebral arteries. World Neurosurg 73:174–185
Lee JY, Kwon BJ, Cho YD, Kang HS, Han MH (2013) Reappraisal of anatomic outcome scales of coiled intracranial aneurysms in the prediction of recanalization. J Korean Neurosurg Soc 53:342–348
Sluzewski M, Van Rooij WJ, Slob MJ, Bescós JO, Slump CH, Wijnalda D (2004) Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 231:653–658
Miyazawa N, Nukui H, Horikoshi T, Yagishita T, Sugita M, Kanemaru K (2002) Surgical management of aneurysms of the bifurcation of the internal carotid artery. Clin Neurol Neurosurg 104:103–114
No funding was received for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
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.
For this type of study formal consent is not required.
Rights and permissions
About this article
Cite this article
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
- Coil embolization
- Internal carotid artery bifurcation
- Intracranial aneurysm