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

Abstract

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...

Validation of the Modified Raymond–Roy classification for intracranial aneurysms treated with coil embolization

“…Ruptured aneurysms, aneurysms with intraluminal thrombus, and incompletely coiled aneurysms are well-documented risk factors for recurrence following coil embolization 10 11. The finding of male gender as an additional risk factor has also been previously reported 9 23…”

Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

“…41 However, incomplete coiling is not the only factor associated with regrowth as increased total aneurysm size, packing density, older age, male sex, hypertension, and ruptured aneurysm have also been associated with aneurysm regrowth after coiling in retrospective analyses. [42][43][44] The mortality rate seems to be high in patients that received surgical retreatment based on our meta-analysis. Another metaanalysis suggested that mortality may actually be 0% (95% CI = 0.0%-2.5%).…”

Recurrence of endovascularly and microsurgically treated intracranial aneurysms—review of the putative role of aneurysm wall biology

“…Analysis of a matched (aneurysm location, diameter, and neck size) cohort demonstrated not only an overall higher risk of recanalization in ruptured IA but also shorter period and higher degrees of recanalization and a higher percentage of retreatment when compared with unruptured IA [95]. It is increasingly recognized that the need of retreatment after GDC embolization are more common in ruptured than unruptured IA [20,38,64,71,72].…”

“…Unruptured IAs tend to have more viable SMCs in their walls, providing unruptured IAs increased opportunity to heal after embolization. This could explain why unruptured IAs have lower rebleeding rates [20,75], necessitate less retreatment [20,31,38,71,72,82], and are more stable after GCD embolization than ruptured IAs [1, 13, 26, 43, 70-72, 78, 95, 101].…”