Skip to main content

Extended monitoring of coiled aneurysms completely occluded at 6-month follow-up: late recanalization rate and related risk factors

Abstract

Objectives

To estimate long-term durability in coiled aneurysms completely occluded at 6-month follow-up imaging, focusing on late recanalization rate and the risk factors involved.

Methods

A cohort of 620 patients harbouring 698 completely occluded coiled aneurysms at 6-month follow-up was subjected to extended monitoring (mean, 24.5 ± 7.9 months). Cumulative recanalization rate and related risk factors were analysed using Cox proportional hazards regression and Kaplan–Meier product-limit estimator.

Results

Forty-three aneurysms (6.2 %) occluded completely at 6-months displayed recanalization (3.02 % per aneurysm-year) during continued surveillance (1425.5 aneurysm-years), with 26 (60.5 %) surfacing in another 6 months, 15 (34.9 %) within 18 months and 2 (4.6 %) within 30 months. Cumulative survival rates without recanalization were significantly lower in subjects with aneurysms >7 mm (p = 0.014), with bifurcation aneurysms (p = 0.009) and with subarachnoid haemorrhage (SAH) at presentation (p < 0.001). Multivariate analysis indicated that aneurysms >7 mm (HR = 2.37, p = 0.02) and bifurcation aneurysms (HR = 2.70, p = 0.03) were significant factors in late recanalization, whereas a link with SAH at presentation was marginal (HR = 1.92, p = 0.06) and stent placement fell short of statistical significance (HR = 0.47; p = 0.12).

Conclusion

Most (93.8 %) coiled aneurysms showing complete occlusion at 6 months post-procedure were stable in long-term monitoring. However, aneurysms >7 mm and bifurcation aneurysms were predisposed to late recanalization.

Key Points

Most coiled aneurysms showing complete occlusion at 6 months were stable.

Forty-three aneurysms (6.2 %) occluded completely at 6-month follow-up displayed late recanalization.

Late recanalization rate was 3.02 % per aneurysm-year during follow-up of 1425.5 aneurysm-years.

Aneurysms over 7 mm and bifurcation aneurysms were predisposed to late recanalization.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Abbreviations

CAD:

coronary artery disease

DM:

diabetes mellitus

DSA:

digital subtraction angiography

HTN:

hypertension

TOF-MRA:

time-of-flight magnetic resonance angiography

UIA:

unruptured intracranial aneurysms

References

  1. Raymond J, Guilbert F, Weill A et al (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403

    Article  PubMed  Google Scholar 

  2. Cho YD, Jeon JP, Rhim JK et al (2015) Progressive thrombosis of small saccular aneurysms filled with contrast immediately after coil embolization: analysis of related factors and long-term follow-up. Neuroradiology 57:615–623

    Article  PubMed  Google Scholar 

  3. Gao B, Baharoglu MI, Cohen AD et al (2012) Stent-assisted coiling of intracranial bifurcation aneurysms leads to immediate and delayed intracranial vascular angle remodeling. Am J Neuroradiol 33:649–654

    CAS  Article  PubMed  Google Scholar 

  4. Cho YD, Lee WJ, Kim KM et al (2013) Stent-assisted coil embolization of posterior communicating artery aneurysms. Am J Neuroradiol 34:2171–2176

    CAS  Article  PubMed  Google Scholar 

  5. Cognard C, Weill A, Spelle L et al (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356

    CAS  Article  PubMed  Google Scholar 

  6. Sluzewski M, van Rooij WJ, Slob MJ et al (2004) Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 231:653–658

    Article  PubMed  Google Scholar 

  7. Morales HG, Kim M, Vivas EE et al (2011) How do coil configuration and packing density influence intra-aneurysmal hemodynamics? Am J Neuroradiol 32:1935–1941

    CAS  Article  PubMed  Google Scholar 

  8. Jeong W, Rhee K (2012) Hemodynamics of cerebral aneurysms: computational analyses of aneurysm progress and treatment. Comput Math Methods Med 2012:782801

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hoi Y, Meng H, Woodward SH et al (2004) Effects of arterial geometry on aneurysm growth: three-dimensional computational fluid dynamics study. J Neurosurg 101:676–681

    Article  PubMed  Google Scholar 

  10. Feng Y, Wada S, Tsubota K et al (2005) The application of computer simulation in the genesis and development of intracranial aneurysms. Technol Health Care 13:281–291

    PubMed  Google Scholar 

  11. Shojima M, Oshima M, Takagi K et al (2004) Magnitude and role of wall shear stress on cerebral aneurysm: computational fluid dynamic study of 20 middle cerebral artery aneurysms. Stroke 35:2500–2505

    Article  PubMed  Google Scholar 

  12. Jeon JS, Ahn JH, Huh W et al (2014) A retrospective analysis on the natural history of incidental small paraclinoid unruptured aneurysm. J Neurol Neurosurg Psychiatry 85:289–294

    Article  PubMed  Google Scholar 

  13. Ingebrigtsen T, Morgan MK, Faulder K et al (2004) Bifurcation geometry and the presence of cerebral artery aneurysms. J Neurosurg 101:108–113

    Article  PubMed  Google Scholar 

  14. Rossitti S, Lofgren J (1993) Vascular dimensions of the cerebral arteries follow the principle of minimum work. Stroke 24:371–377

    CAS  Article  PubMed  Google Scholar 

  15. Nguyen TN, Hoh BL, Amin-Hanjani S et al (2007) Comparison of ruptured vs unruptured aneurysms in recanalization after coil embolization. Surg Neurol 68:19–23

    Article  PubMed  Google Scholar 

  16. Niimi Y, Song J, Madrid M et al (2006) Endosaccular treatment of intracranial aneurysms using matrix coils: early experience and midterm follow-up. Stroke 37:1028–1032

    Article  PubMed  Google Scholar 

  17. Seibert B, Tummala RP, Chow R et al (2011) Intracranial aneurysms: review of current treatment options and outcomes. Front Neurol 2:45

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hetts SW, Turk A, English JD et al (2014) Stent-assisted coiling versus coiling alone in unruptured intracranial aneurysms in the matrix and platinum science trial: safety, efficacy, and mid-term outcomes. Am J Neuroradiol 35:698–705

    CAS  Article  PubMed  Google Scholar 

  19. Lawson MF, Newman WC, Chi YY et al (2011) Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69:598–603

    Article  PubMed  Google Scholar 

  20. Chalouhi N, Jabbour P, Singhal S et al (2013) Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 44:1348–1353

    Article  PubMed  Google Scholar 

  21. Hwang SK, Hwang G, Bang JS et al (2013) Endovascular Enterprise stent-assisted coil embolization for wide-necked unruptured intracranial aneurysms. J Clin Neurosci 20:1276–1279

    Article  PubMed  Google Scholar 

  22. Luo CB, Teng MM, Chang FC et al (2012) Stent-assisted coil embolization of intracranial aneurysms: a single center experience. J Chin Med Assoc 75:322–328

    Article  PubMed  Google Scholar 

  23. Park JH, Kang HS, Han MH et al (2011) Embolization of intracranial aneurysms with HydroSoft coils: results of the Korean multicenter study. Am J Neuroradiol 32:1756–1761

    CAS  Article  PubMed  Google Scholar 

  24. Ortiz R, Song J, Niimi Y et al (2008) Rate of recanalization and safety of endovascular embolization of intracranial saccular aneurysms framed with GDC 360 coils. Interv Neuroradiol 14:397–401

    CAS  PubMed  Google Scholar 

  25. Ferns SP, Sprengers ME, van Rooij WJ et al (2011) Late reopening of adequately coiled intracranial aneurysms: frequency and risk factors in 400 patients with 440 aneurysms. Stroke 42:1331–1337

    Article  PubMed  Google Scholar 

  26. Lin T, Fox AJ, Drake CG (1989) Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556–560

    CAS  Article  PubMed  Google Scholar 

  27. Kwon SC, Kwon OK, Korean Unruptured Cerebral Aneurysm Coiling I (2014) Endovascular coil embolization of unruptured intracranial aneurysms: a Korean multicenter study. Acta Neurochir (Wien) 156:847–854

    Article  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Young Dae Cho. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Sung-Eun Kim kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, case-control study, performed at one institution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Young Dae Cho.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jeon, J.P., Cho, Y.D., Rhim, J.K. et al. Extended monitoring of coiled aneurysms completely occluded at 6-month follow-up: late recanalization rate and related risk factors. Eur Radiol 26, 3319–3326 (2016). https://doi.org/10.1007/s00330-015-4176-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-4176-3

Keywords

  • Aneurysms
  • Stent
  • Recanalization
  • Occlusion
  • Coiling