Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

Abstract

Object Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment. Methods Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images. Results Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment. Conclusions The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.

Factors that determine aneurysm occlusion after embolization with the Woven EndoBridge (WEB)

“…Male sex as potential factor influencing aneurysm occlusion is unknown related to WEB treatment, but has already been described for conventional coil embolization 22. The association between gender and aneurysm progression has not yet been studied in detail.…”

Blood Flow Into Basilar Tip Aneurysms

“…11,12 Recent studies have revealed that recanalization after coil embolization occurs not only in the short term (typically within 1 year) but also in the long term (after several years). 1,[13][14][15][16] Repeated angiographic examinations or treatments because of the recanalization of coiled aneurysms result in a significant reduction in patient quality of life.…”

Clinical and Imaging Follow-Up of Patients with Coiled Basilar Tip Aneurysms Up to 20 Years

“…In 1 previous study, male sex was also found to be a risk factor for reopening after coiling. 7 Rebleeds occurred in 9 of 106 patients with ruptured basilar tip aneurysms who survived the admission period at time intervals ranging from 4 months to 16.6 years after coiling. In 3 patients, the rebleed was fatal.…”

“…1 Risk factors for reopening with time are large aneurysm size, a wide neck, the presence of intraluminal thrombus, low packing attenuation, initial incomplete occlusion, duration of follow-up, and location in the posterior circulation. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In general, additional coiling is advocated in reopened aneurysms to prevent rebleeding. Most reopenings occur in the first year after coiling and become apparent at the first imaging follow-up after 6 -12 months.…”

“…A first time reopening beyond the 12-month follow-up is infrequent. 6,7,9,10,12,13 Aneurysms at the basilar tip form a special subset of intracranial aneurysms. First, surgery is a less likely option in these aneurysms, and even aneurysms with unfavorable configuration are coiled, whereas unfavorable aneurysms in the anterior circulation can be clipped.…”