Follow-up Angiography of Intracranial Aneurysms Treated with Endovascular Placement of Guglielmi Detachable Coils

Thornton, John; Debrun, Gérard; Aletich, Victor; Bashir, Qasim; Charbel, Fady T.; Ausman, James I.

doi:10.1227/00006123-200202000-00003

Cited by 22 publications

(26 citation statements)

References 23 publications

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“…2,34) The immediate angiographic results in aneurysms with later recanalization and regrowth are often unsatisfactory. 22,24,43) Aneurysms completely embolized with GDCs were permanently excluded from the circulation. 29) However, in our series, three of 56 completely occluded aneurysms manifested recanalization.…”

Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The present study assessed the safety and efficacy of embolization using Guglielmi detachable coils (GDCs) in 100 asymptomatic cerebral aneurysms classified as sidewall (70) or terminal (30) aneurysms according to the parent artery (68 small aneurysms with a small neck, 21 small aneurysms with a wide neck, and 11 large aneurysms). A balloon-assisted technique was used in 49 aneurysms. Immediate angiography revealed that 71 aneurysms were completely obliterated. Transient deficits occurred in 19 patients, permanent deficits in four patients, and one patient died. Most complications occurred during or immediately after treatment and resolved within a few minutes to a few weeks. None of the surviving patients manifested significant morbidity at 1-year follow up. Follow-up angiographic study was performed in 79 aneurysms. Rates of recanalization and progressive thrombosis (total occlusion of the residual aneurysm at follow up) were 11% and 38%, respectively, in sidewall aneurysms, and 26% and 0%, respectively, in terminal aneurysms. Treatment with GDCs was effective for patients with small aneurysms with small necks, the morbidity was acceptable, and progressive thrombosis occurred during the follow-up period. GDC treatment achieved unsatisfactory results in patients with small terminal aneurysms with wide necks and in large aneurysms, because the obliteration rate was low, and the recanalization and complication rates were high. Multivariate analysis showed that complete occlusion was associated with small-necked aneurysms, and ischemic events tended to occur in terminal aneurysms and in aneurysms treated by the balloon-assisted technique.

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Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…Recurrence after coiling is an outcome with unknown clinical significance, notwithstanding potential association with a higher rate of rupture, rerupture and retreatment 6,15,18,20,24 . To enable prevention it is critical to understand associated risk factors and the type of recurrence post coiling that is associated with poor clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…The main challenge lies in the fact that the definition of "recurrence" varies greatly in the literature. This variability generates a wide range of recurrence rates and results with considerable range in its association with multiple potential risk factors 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . We applied a strict definition of recurrence and major recurrence and analyzed the relationship between several clinical, anatomical and technical data as a surrogate of major recurrence using survival analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The currently known potential risk factors associated with post-coiling recurrence include large aneurysm size 8 , presence of intraluminal thrombus 9 , low packing density [10][11][12] , initial incomplete occlusion 5,[13][14][15][16] , duration of follow-up 5,17 , ruptured status at presentation 5,18,19 , location in the posterior circulation 7,14,20,21 , neck width size >4 mm 22 , and unfavorable dome-to-neck ratio 4 . However, the available literature analyzing post-coiling recurrence has limitations such as lack of data on individual patients or individual aneurysms (due to mostly aggregated data being available), limited sample size, high rate of incomplete follow-up, wide variation in the schedule and modality of angiographic follow-up, limited heterogeneity in the location, status, types and the sizes of the aneurysms studied, and inconsistent definition of recurrence 7 .…”

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confidence: 99%

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Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

Santos

Sabri

Dowlatshahi

et al. 2015

Can. J. Neurol. Sci.

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Background: Recurrence after intracranial aneurysm coiling is a highly prevalent outcome, yet to be understood. We investigated clinical, radiological and procedural factors associated with major recurrence of coiled intracranial aneurysms. Methods: We retrospectively analyzed prospectively collected coiling data . We recorded characteristics of aneurysms, patients and interventional techniques, pre-discharge and angiographic follow-up occlusion. The Raymond-Roy classification was used; major recurrence was a change from class I or II to class III, increase in class III remnant, and any recurrence requiring any type of retreatment. Identification of risk factors associated with major recurrence used univariate Cox Proportional Hazards Model followed by multivariate regression analysis of covariates with P < 0.1. Results: A total of 467 aneurysms were treated in 435 patients: 283(65%) harboring acutely ruptured aneurysms, 44(10.1%) patients died before discharge and 33(7.6%) were lost to follow-up. A total of 1367 angiographic follow-up studies (range: 1-108 months, Median [interquartile ranges (IQR)]: 37[14-62]) was performed in 384(82.2%) aneurysms. The major recurrence rate was 98(21%) after 6(3.5-22.5) months. Multivariate analysis (358 patients with 384 aneurysms) revealed the risk factors for major recurrence: age > 65 y (hazard ratio (HR): 1.61; P = 0.04), male sex (HR: 2.13; P < 0.01), hypercholesterolemia (HR: 1.65; P = 0.03), neck size ≥4 mm (HR: 1.79; P = 0.01), dome size ≥7 mm (HR: 2.44; P < 0.01), non-stent-assisted coiling (HR: 2.87; P = 0.01), and baseline class III (HR: 2.18; P < 0.01). Conclusion: Approximately one fifth of the intracranial aneurysms resulted in major recurrence. Modifiable factors for major recurrence were choice of stent-assisted technique and confirmation of adequate baseline occlusion (Class I/II) in the first coiling procedure. La classification Raymond-Roy a été utilisée: une récidive majeure était définie comme un changement de la classe I ou II à la classe III, une augmentation résiduelle de classe III et une récidive nécessitant tout type de réintervention. Les facteurs de risque associés à une récidive majeure ont été identifiés au moyen du modèle des risques proportionnels de Cox suivi d'une analyse de régression multivariée des covariables, p < 0,01. Résultats: Au total, 467 anévrismes ont été traités chez 435 patients: 283 patients (65%) présentaient une rupture aiguë de l'anévrisme, 44 patients (10,1%) sont décédés avant le congé hospitalier et 33 (7,6%) ont été perdus au suivi. En tout, 1367 études angiographiques de suivi (écart de 1 à 108 mois ; médiane 37 ; écarts interquartiles de 14 à 62 mois) ont été effectuées pour 384 anévrismes (82,2%). Le taux de récidive majeure a été de 21% (98) après 6 mois (3,5 à 22,5 mois). L'analyse multivariée (358 patients porteurs de 384 anévrismes) a montré que les facteurs de risque d'une récidive majeure étaient: l'âge > 65 ans (risque relatif (RR): 1,61 ; p = 0,04), le sexe masculin (RR: 2,13 ; p < 0,01), l'hypercho...

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“…[10][11][12] This recanalization, however, was found to be associated with larger aneurysms and those with a poor dome-to-neck ratio. 10 Despite the fact that microsurgical clipping provides a far superior anatomic cure compared to endovascular coiling, coiling has been shown to be effective in changing the natural history of unruptured and ruptured aneurysms as well.…”

Section: Comparison Of Endovascular Occlusion and Microsurgical Exclumentioning

confidence: 95%

Adenosine-Induced Transient Asystole

Britz

2014

Methodist DeBakey Cardiovascular Journal

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Follow-up Angiography of Intracranial Aneurysms Treated with Endovascular Placement of Guglielmi Detachable Coils

Cited by 22 publications

References 23 publications

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

Adenosine-Induced Transient Asystole

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