Long-term follow-up of endovascular coil embolization for cerebral aneurysms using three-dimensional time-of-flight magnetic resonance angiography

Abstract

Objectives: As endovascular treatment becomes more prevalent, aneurysm recurrence from neck remnants, recanalization, incomplete obliteration and bleeding remain major concerns. In the current analysis, we attempted to identify factors related to disease progression and clinical outcome in patients treated with coil embolization. Methods: This study included 58 patients who underwent endovascular coil embolization for treatment of intracranial aneurysm. The result of embolization was evaluated with threedimensional time-of-flight magnetic resonance angiography (TOF MRA) and classified as a complete occlusion, a residual neck (minor, central and marginal types), a residual dome (central and marginal types). Patients were followed up clinically and radiologically. Statistical analyses were performed to establish factors that influenced the occurrence of adverse events such as recurrence of aneurysm. Results: Overall, the complete occlusion rate was 18.8%, the occurrence of a residual neck was 67.2%, and the residual dome rate was 14.1%. The mean clinical follow-up was 31.2 months. Recurrences were found in 18 aneurysms, and major recurrences were retreated with coiling or surgery. The post-treatment study revealed that the marginal-type aneurysm filling has a significant impact on outcome. Thus, perianeurysmal edema was correlated with recurrence of the aneurysm. Conclusions: Three-dimensional TOF MRA was a sensitive tool for visualizing residual filling of embolized aneurysm and is useful for long-term follow-up of patients. [Neurol Res 2008; 000: 000-000]

Treatment of intra-cranial aneurysms with the SILK flow diverter: 2 years’ experience with 28 patients at a single center

“…This complication is known in the treatment of large aneurysms treated with coils only without a flow diverter [5,7]. The exact mechanism is not completely clear.…”

Perianeurysmal vasogenic oedema (PAVO) following aneurysm embolisation: a unique case of asymptomatic long-term progression and review of the literature

“…All 8.6% cases of PAVO in one series were associated with aneurysm recanalisation2 of which at least three improved with re-treatment of the aneurysm 3. However, Su et al report no statistically significant correlation between PAVO and aneurysm recanalisation, but describe three cases, at least two of which improved with re-treatment of the aneurysm 4…”

“…The majority of the case reports describe symptoms, whereas the three case series with routine postembolisation MRI imaging, 0/455 and 1/104 are symptomatic; the third is not mentioned 2. The asymptomatic cases were not treated and three cases with minor self-limiting symptoms including hypoesthesia,18 intermittent paraesthesia14 and hypersomnolence17 were not treated.…”

Magnetic resonance angiography or digital subtraction catheter angiography for follow‐up of coiled aneurysms: Do we need both?

“…Since the Kwee study, further reports have shown TOF‐MRA to be an excellent imaging modality for follow‐up of coiled aneurysms . Of those studies that looked specifically at whether MRA can replace DSA as the primary imaging modality for follow‐up of intracranial aneurysm coiling, only one concluded that DSA could not be replaced .…”

“…Since the Kwee study, further reports have shown TOF-MRA to be an excellent imaging modality for follow-up of coiled aneurysms. 14,16,17,[21][22][23] Of those studies that looked specifically at whether MRA can replace DSA as the primary imaging modality for follow-up of intracranial aneurysm coiling, 14,16,17,24 only one concluded that DSA could not be replaced. 24 Deutschmann et al, 25 while investigating the effect of aneurysm size and location on diagnostic accuracy of TOF-MRA, found that TOF-MRA was worse than DSA for detection of recurrence if the aneurysm was <3 mm.…”