5-Year Angiographic and Clinical Follow-up of Coil-Embolised Intradural Saccular Aneurysms

Abstract

<jats:p> The purpose of the paper is the follow-up of embolised intradural saccular Arterial Aneurysms (AA), excluding giant, dissecting, inflammatory, fusiform or AA associated to BVAM. </jats:p><jats:p> Since its introduction in 1991, the Guglielmi Detachable Coil has offered protection against aneurysmal rebleeding in the critical few days and months after SAH regardless of the grade. A number of questions remain: is complete angiographic obliteration necessary at first embolisation? What duration of clinical / angiographic follow-up (FU) is required to ensure the risk of haemorrhage has been eliminated? What is the long-term protection against rebleeding? </jats:p><jats:p> One hundred and two patients with 160 intradural saccular AA embolised before april 1997 were selected for this study. They had at least 5-yrs clinical FU, of which 22 patients had a mid-term (3 years) and 45 patients had a 5-year or more angiographic FU (mean 67,7 months per patient). </jats:p><jats:p> Twenty-eight embolised AAs with 100% occlusion at 1 year, remained unchanged on the 5-year angiograms. A further 14 patients with complete occlusion at 1 year showed persisting complete occlusion on angiogram at 3-years FU, which in our series means that complete occlusion after the first year post-embolisation implies that the aneurysm will remain completely occluded. All secondary spontaneous thromboses (27.6% of cases), occurred during the first year pos-embolisation. In six patients with subtotal or partial occlusion no change was seen for three consecutive years of FU; none showed later change at 5-year angiography. Below 80% occlusion our series does not provide enough information but we consider the situation instable. </jats:p><jats:p> No mortality related to the procedure was observed in the unruptured AA group. No bleeding or re-bleeding has occurred since the beginning of our experience (1993) in saccular AA treated by GDC-Coil. Coil-embolisation of properly selected patients is effective in protecting against bleeding or re-bleeding at short and long-term with stable morphological results provided a strict follow-up control is established at short term. </jats:p>

Intradural Saccular Aneurysms Treated by Guglielmi Detachable Bare Coils at a Single Institution Between 1993 and 2005

“…The study comprises relatively high standards of combined clinical and morphological follow-up and to our knowledge presents the longest clinical follow-up time for this technique so far. The data show, in accordance with previous studies, 1,2,[5][6][7][8]11,12 that morphological loss after coil treatment is relatively common. The present long-term clinical follow-up data with this regimen show a very low rebleed rate despite the fact that no stents or modified coils were used and excellent clinical outcome data in comparison with the literature.…”

“…From previous assessment, a treatment result was considered stable if 2 consecutive angiograms, within a minimum 12-month interval, were identical. 1 We excluded patients who had not yet had the possibility to achieve an angiographically confirmed stable treatment result, ie, patients who were treated during the last 15 months before the start of data analysis. Any special feature encountered at the time of the first treatment, or multifocality, could alter the frame described.…”

“…1,2,5,6,8,9,12,13 We believe that ruptured and unruptured AAs represent different disease entities or aneurysm states with regard to its natural history and treatment strategy, and therefore, the results for these entities were separated within the article to make relevant conclusions possible.…”

“…Previous reports indicate that the majority of, but not all, changes in angiographic appearance occur during the first year after embolization. 1,2,[5][6][7][8] Recent studies have indeed pointed to the fact that later recurrences do occur, 11,12 and therefore it is of interest to identify those parameters that predict the stability of an achieved treatment result. On the basis of previous assessments, we hypothesized that an unchanged angiographic result, with or without a remnant during a 12-month interval, could predict the future morphological result.…”

“…The main concern still remains as to whether the relatively high early minor recanalization rates, 11.9% to 33.6%, [1][2][3][4][5][6][7][8] and the "stable" AA remnants that are found in 16.2% to 26% of Guglielmi detachable bare coil (GDC)-treated patients [1][2][3]6,8,9 inflict a threat to the long-term clinical results in this patient group. In addition, long-term clinical results for completely occluded AAs are still lacking.…”