Skip to main content
SpringerLink
Log in

Progressive thrombosis of small saccular aneurysms filled with contrast immediately after coil embolization: analysis of related factors and long-term follow-up

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Although it is well-known that incomplete occlusion of aneurysms after coil embolization predisposes to later recanalization, not all aneurysms will be fully occluded by coiling. In follow-up, we evaluated outcomes of small aneurysms (<10 mm) that showed filling of the sac with contrast immediately after coil embolization and assessed factors implicated in subsequent progressive thrombosis.

Methods

Between January 2008 and December 2010, a total of 1035 aneurysms in 898 patients were treated by endovascular coiling. Of these, 210 small aneurysms displayed filling of the sac by contrast immediately after coil embolization. Time-of-flight magnetic resonance angiography (TOF-MRA; at 6, 12, 24, and 36 months) and digital subtraction angiography (as needed) were used for postoperative monitoring. Complete occlusion of these aneurysms at the 6-month follow-up point was attributed to progressive thrombosis.

Results

In 186 (88.5 %) of the 210 aneurysms that showed filling of the sac with contrast, complete occlusion was observed on follow-up imaging studies at 6 months. Multiple logistic regression analysis indicated that progressive thrombosis was linked to aneurysmal neck diameter ≤4 mm (p < 0.001) and packing density >30 % (p = 0.016). Aneurysms originating from non-branching vessels were of marginal statistical significance (p = 0.056). In 179 progressively thrombosed aneurysms with follow-up evaluations of ≥12 months (mean, 31.9 ± 7.6 months), 168 aneurysms (93.9 %) exhibited stable occlusion, whereas minor recanalization was observed in 6 (3.3 %) instances, and major recanalization occurred in 5 (2.8 %).

Conclusions

In aneurysms where filling of the sac with contrast was demonstrable after coil embolization, aneurysms with small neck diameters or high coil packing density, and non-branching aneurysms seem predisposed to progressive intra-aneurysmal thrombosis over the course of time.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hwang G, Jung C, Sheen SH et al (2010) Two-year follow-up of contrast stasis within the sac in unruptured aneurysm coil embolization: progressive thrombosis or enlargement? AJNR Am J Neuroradiol 31:1929–1934

    Article  CAS  PubMed  Google Scholar 

  2. Gallas S, Januel AC, Pasco A et al (2009) Long-term follow-up of 1036 cerebral aneurysms treated by bare coils: a multicentric cohort treated between 1998 and 2003. AJNR Am J Neuroradiol 30:1986–1992

    Article  CAS  PubMed  Google Scholar 

  3. Cho YD, Lee JY, Seo JH et al (2012) Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms. Neuroradiology 54:719–726

    Article  PubMed  Google Scholar 

  4. Baharoglu MI, Lauric A, Gao BL et al (2012) Identification of a dichotomy in morphological predictors of rupture status between sidewall- and bifurcation-type intracranial aneurysms. J Neurosurg 116:871–881

    Article  PubMed  Google Scholar 

  5. Bendok BR, Parkinson RJ, Hage ZA et al (2007) The effect of vascular reconstruction device-assisted coiling on packing density, effective neck coverage, and angiographic outcome: an in vitro study. Neurosurgery 61:835–840

    Article  PubMed  Google Scholar 

  6. Cho YD, Lee WJ, Kim KM et al (2013) Endovascular coil embolization of middle cerebral artery aneurysms of the proximal (M1) segment. Neuroradiology 55:1097–1102

    Article  PubMed  Google Scholar 

  7. Kang HS, Han MH, Kwon BJ et al (2010) Is clopidogrel premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms? Neurosurgery 67:1371–1376

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  9. Molyneux A, Kerr R, Stratton I et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  10. Wiebers DO, Whisnant JP, Huston J 3rd et al (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110

    Article  PubMed  Google Scholar 

  11. Cho YD, Sohn CH, Kang HS et al (2014) Coil embolization of intracranial saccular aneurysms using the Low-profile Visualized Intraluminal Support (LVIS™) device. Neuroradiology 56:543–551

    Article  PubMed  Google Scholar 

  12. Ferns SP, Sprengers ME, van Rooij WJ et al (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40:e523–529

    Article  PubMed  Google Scholar 

  13. Lee D, Yuki I, Murayama Y et al (2007) Thrombus organization and healing in the swine experimental aneurysm model. Part I. A histological and molecular analysis. J Neurosurg 107:94–108

    Article  CAS  PubMed  Google Scholar 

  14. Kwon BJ, Im SH, Park JC et al (2010) Shaping and navigating methods of microcatheters for endovascular treatment of paraclinoid aneurysms. Neurosurgery 67:34–40

    Article  PubMed  Google Scholar 

  15. Sorimachi T, Ito Y, Morita K et al (2012) Long-term follow-up of intra-aneurysmal coil embolization for unruptured paraclinoid aneurysms. Neurol Res 34:864–870

    Article  PubMed  Google Scholar 

  16. Kwon WH, Jeong HW, Kim ST et al (2014) Angiographic and clinical result of endovascular treatment in paraclinoid aneurysms. Neurointervention 9:83–88

    Article  PubMed Central  PubMed  Google Scholar 

  17. Mascitelli JR, Moyle H, Oermann EK et al (2014) An update to the Raymond-Roy Occlusion Classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg 2014 Jun 4 [Epub ahead of print]

  18. Ng P, Khangure MS, Phatouros CC et al (2002) Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke 33:210–217

    Article  CAS  PubMed  Google Scholar 

  19. Im SH, Han MH, Kwon OK et al (2009) Endovascular coil embolization of 435 small asymptomatic unruptured intracranial aneurysms: procedural morbidity and patient outcome. AJNR Am J Neuroradiol 30:79–84

    Article  PubMed  Google Scholar 

  20. Cho YD, Kim KM, Lee WJ et al (2014) Time-of-flight magnetic resonance angiography for follow-up of coil embolization with enterprise stent for intracranial aneurysm: usefulness of source images. Korean J Radiol 15:161–168

    Article  PubMed Central  PubMed  Google Scholar 

  21. Pierot L, Portefaix C, Boulin A et al (2012) Follow-up of coiled intracranial aneurysms: comparison of 3D time-of-flight and contrast-enhanced magnetic resonance angiography at 3T in a large, prospective series. Eur Radiol 22:2255–2263

    Article  PubMed  Google Scholar 

  22. Schaafsma JD, Velthuis BK, Majoie CB et al (2010) Intracranial aneurysms treated with coil placement: test characteristics of follow-up MR angiography-multicenter study. Radiology 256:209–218

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Yoon-Kyung Choi for preparation of the illustrations. This study was supported by grant no. 04-2013-0690 from the SNUH Research Fund.

Ethical Standards and Patient Consent

We declare that all human and animal studies have been approved by our Institutional Review Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Seoul, Korea

    Young Dae Cho, Jin Pyeong Jeon, Jong Kook Rhim, Jeong Jin Park, Roh-Eul Yoo & Moon Hee Han

  2. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

    Hyun-Seung Kang, Jeong Eun Kim, Won-Sang Cho & Moon Hee Han

Authors
  1. Young Dae Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin Pyeong Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jong Kook Rhim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeong Jin Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roh-Eul Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyun-Seung Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jeong Eun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Won-Sang Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Moon Hee Han
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Moon Hee Han.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cho, Y.D., Jeon, J.P., Rhim, J.K. et al. 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 (2015). https://doi.org/10.1007/s00234-015-1514-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-015-1514-8

Keywords

Search

Navigation