Angiographic Results of Wide-Necked Intracranial Aneurysms Treated with Coil Embolization : A Single Center Experience

Abstract

ObjectiveEndovascular treatment of wide-necked intracranial aneurysms is a challenge and the durability and the safety of these treated aneurysms remain unknown. The aim of this study was to evaluate the clinical and long-term angiographic results of wide-necked intracranial aneurysms treated with coil embolization.MethodsBetween January 2002 and December 2012, 53 wide-necked aneurysms treated with coil embolization were selected. Forty were female, and 13 were male. Twenty eight (52.8%) were ruptured aneurysms, and 25 (47.2%) were unruptured aneurysms. The patents' medical and radiological records were reviewed retrospectively.ResultsOf the 53 aneurysms, coiling alone was employed in 45 (84.9%) and stent-assisted coiling was done in 8 (15.1%). The initial angiographic results revealed Raymond class 1 (complete occlusion) in 30 (56.6%) cases, Raymond class 2 (residual neck) in 18 (34.0%) cases, and Raymond class 3 (residual sac) in 5 (9.4%) cases. The mean angiographic follow-up period was 37.9 months (12-120 months). At the last angiographies, Raymond class 1 was seen in 26 (49.1%) cases, Raymond class 2 in 16 (30.2%), and Raymond class 3 in 11 (20.8%). Angiographic recurrence occurred in 22 (41.5%) patients, with minor recurrence in 7 (13.2%) cases and major recurrence in 15 (28.3%). Retreatment was performed in 8 cases (15.1%). A suboptimal result on the initial angiography was a significant predictor of recurrence in this study (p=0.03).ConclusionThe predictor of recurrence in wide-necked aneurysms is a suboptimal result on the initial angiography. Long-term angiographic follow-up is recommended in wide-necked aneurysms.

The SMART Registry: Long-Term Results on the Utility of the Penumbra SMART COIL System for Treatment of Intracranial Aneurysms and Other Malformations

“…The patients treated for WNA had low procedural device-related safety events (2.5%) and low retreatment rates (7.4%) through 1-year. These outcomes are consistent with other reports of coiled WNA (18)(19)(20)(21)(22)(23). Patients with ruptured aneurysms in our study achieved high occlusion rates at 1-year (RROC I + II 84.3%) and as expected, these patients had higher rates of recanalization and retreatment compared to those patients treated for unruptured aneurysms.…”

Current Trends and Results of Endovascular Treatment of Unruptured Intracranial Aneurysms at a Single Institution in the Flow-Diverter Era

“…Of these, 2690 aneurysms (57.7%) were completely occluded and 1490 (31.9%) had small residual necks. The rate of incomplete occlusion following coiling ranged from 1.2% to 20.8% in larger studies, [17][18][19][20][21][22][23] similar to our finding of 8% in the coiling group. The rate of complete occlusion in the FD group with at least 6 months of follow-up of 64.4% is lower than that in other flow-diverter studies; however, the low rate of retreatment (6%) is in line with those previously reported.…”

Comparison of Long-Term Angiographic Results of Wide-Necked Intracranial Aneurysms : Endovascular Treatment with Single-Microcatheter Coiling, Double-Microcatheter Coiling, and Stent-Assisted Coiling

“…We chose patients, with wide-necked aneurysm and long-term follow-up periods after initial coil embolization, from four hospitals regardless of age and sex between January 2003 and October 2016. As our previous report in 2015 [ 27 ], aneurysms were considered wide-necked if the neck was larger than 4 mm or the dome-to-neck ratio was less than 2, and the follow-up period was considered long-term if it was longer than 3 years after the initial embolization. Aneurysms less than 4 mm in neck size and patients with a follow-up period of less than 3 years were excluded.…”

“…The RROC was used on follow-up angiographic results, similar to the immediate post-procedural evaluation; class I represents complete obliteration of both the aneurysmal neck and sac; class II represents partial obliteration of the aneurysm with a residual neck; and class III denotes incomplete obliteration of the aneurysm with a residual sac. Angiographic recurrence was defined as new contrast filling, or any enlarged contrast filling area of the aneurysmal neck or sac in follow-up angiographies [ 27 ]. To assess the durability and stability of the coil embolization, we subdivided recurrence into minor and major groups.…”

“…A major recurrence was defined as a new contrast filling of the aneurysmal sac, which was previously completely occluded, or an increase in the filling of the sac ( Fig. 5 ) [ 27 ]. The mean follow-up period was 58.36±25.08 months, ranging from 36 to 131 months.…”