Thirteen-year experience with coil embolization of 481 ruptured intracranial aneurysms: angiographic and clinical results

Abstract

, 481 patients with ruptured aneurysms were referred for endovascular treatment with detachable coils at our center. The technical feasibility, procedural complications, morbidity, mortality, and initial angiographic and clinical results were evaluated. RESULTSEndovascular treatment was successful in 95.6% of the patients. Postembolization angiography showed complete occlusion in 63.4%, a neck remnant in 30.8%, and incomplete occlusion in 5.8% of the aneurysms. A total of 331 patients were followed up. The overall angiographic results showed stable occlusion in 234 aneurysms (70.7%) and recurrence in 97 aneurysms (29.3%). During the follow-up period, stable angiographic occlusion was evident in 75% of the small, 61% of the large, and 38.5% of the giant aneurysms. Complications during the coiling procedure occurred in 75 procedures (15.6%). Ischemic complications were observed in 33 procedures (6.9%), and perforation of the aneurysm during the coiling occurred in 12 cases (2.5%). Five (41.7%) of 12 patients who had perforation during coiling died. The overall procedure-related morbidity and mortality were 5.6% and 2%, respectively. During the follow-up period, two patients (0.4%) had early rebleeding. None of the patients showed late rebleeding. In the follow-up, the retreatment rate was 12.6%. CONCLUSION Our data confirm the feasibility, safety, and efficacy of endovascular coil embolization in patients with ruptured cerebral aneurysms.

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

“…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. These findings are consistent with previous reports in real-world registries treating ruptured aneurysms with endovascular coiling (24)(25)(26). The SMART ruptured aneurysm subgroup achieved occlusion comparable to other studies evaluating ruptured aneurysms treated with bare metal coils (24).…”

Neurosurgery and pregnancy

“…Coil embolization initially reserved for patients with poorer grades and those unfit for extensive intracranial procedures, is no longer considered so. The safety and efficacy of coil embolization is established [21] and it is an effective option in pregnant patients with a ruptured or unruptured aneurysm. Procedure can be done under sedation and local anaesthesia at femoral cannulation site or can be done under general anaesthesia.…”

Novel Hybrid Flow Diverter for Intracranial Aneurysm

“…In addition, although post-embolization angiography can show the degree of occlusion, the density of the coil packing cannot be adjusted, which may result in unstable and non-uniform strength. Also, if an aneurysm is not under equilibrium stress when the coils are inserted, it may cause the micro-catheter, guidewire, or coil to penetrate the aneurysm, leading to rupture and hemorrhage [6][7][8][9].…”