Sixteen-year single-surgeon experience with coil embolization for ruptured intracranial aneurysms: recurrence rates and incidence of late rebleeding

Clinical article

Restricted access

Object

Over a 16-year period, 570 patients presenting with acute aneurysmal subarachnoid hemorrhage were successfully treated using endosaccular coil embolization within 30 days of hemorrhage by a single surgeon. Patients were followed to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting against rebleeding.

Methods

Patients were followed for 6 to 191 months (mean 73.7 months, median 67 months) by clinical review, angiography performed at 6 and 24 months posttreatment, and questionnaires sent via the postal service every 5 years. Late rebleeding was defined as > 30 days after treatment.

Results

Stable angiographic occlusion was evident in 74.5% of small, 72.2% of large, and 60% of giant aneurysms. Recurrent filling was found in 119 (26.3%) of 452 aneurysms. Rebleeding was diagnosed in 9 patients (6 treated aneurysms) and occurred between 2 and 114 months posttreatment. It was due to aneurysm recurrence in 6 patients, rupture of a coincidental untreated aneurysm in 2 patients, and rupture of a de novo aneurysm in 1 patient. Rebleeding occurred in 3 (2.5%) of 119 unstable aneurysms and in 3 (0.9%) of 333 stable aneurysms, as seen on initial follow-up angiography studies. Annual rebleeding rates ranged from 0.2% to 0.6% for all causes and from 0.2% to 0.4% for rebleeding of treated aneurysms. No rebleeding was recorded after the first decade, with 138 patients having more than 10 years of follow-up.

Conclusions

Periodic follow-up with angiographic studies after coil embolization is recommended to identify aneurysm recurrence and patients at a high risk of late rebleeding in the medium term. More frequent follow-up is recommended for patients harboring coincidental unruptured aneurysms.

Abbreviations used in this paper: ACA = anterior cerebral artery; ACoA = anterior communicating artery; BA = basilar artery; DS = digital subtraction; EOT = end of treatment; EVT = endovascular treatment; GOS = Glasgow Outcome Scale; ISAT = International Subarachnoid Aneurysm Trial; MCA = middle cerebral artery; mRS = modified Rankin Scale; OG = Occlusion Grade; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage; UK = United Kingdom; WFNS = World Federation of Neurosurgical Societies.

Article Information

Address correspondence to: James V. Byrne, M.D., F.R.C.S., F.R.C.R., Department of Neuroradiology, Level 01, West Wing, The John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom. email: james.byrne@nds.ox.ac.uk.

Please include this information when citing this paper: published online July 30, 2010; DOI: 10.3171/2010.6.JNS091058.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Flow chart showing numbers of patients undergoing 6-month and subsequent follow-up angiography.

  • View in gallery

    Bar graph showing a comparison of aneurysm fundus size and neck size with angiographic stability at 6 months postembolization. The values on the y axis represent the percentage of aneurysms.

References

1

Aikawa HKazekawa KNagata SOnizuka MIko MTsutsumi M: Rebleeding after endovascular embolization of ruptured cerebral aneurysms. Neurol Med Chir (Tokyo) 47:4394672007

2

Byrne JVMolyneux AJBrennan RPRenowden SA: Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 59:6166201995

3

Byrne JVSohn MJMolyneux AJChir B: Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg 90:6566631999

4

Campi ARamzi NMolyneux AJSummers PEKerr RSSneade M: Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 38:153815442007

5

CARAT Investigators: Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke 37:143714422006

6

Casasco AEAymard AGobin YPHoudart ERogopoulos AGeorge B: Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 79:3101993

7

Cognard CWeill ACastaings LRey AMoret J: Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:4995101998

8

Cognard CWeill ASpelle LPiotin MCastaings LRey A: Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:3483561999

9

Drake CGHunt WEKassell NPertuiset BSano KTeasdale G: Report of the World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 68:9859861988. (Letter)

10

Eskridge JMSong JK: Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 89:81861998

11

Ferns SPSprengers MEvan Rooij WJRinkel GJvan Rijn JCBipat S: Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40:e523e5292009

12

Friedman JANichols DAMeyer FBPichelmann MAMcIver JIToussaint LG III: Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. AJNR Am J Neuroradiol 24:5265332003

13

Gallas SPasco ACottier JPGabrillargues JDrouineau JCognard C: A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 26:172317312005

14

Guglielmi G: History of the genesis of detachable coils. A review. J Neurosurg 111:182009. [epub ahead of print March 13 2009; DOI: 10.3171/2009.2.JNS081039]

15

Henkes HFischer SLiebig TWeber WReinartz JMiloslavski E: Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery 58:2242322006

16

Hope JKByrne JVMolyneux AJ: Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. AJNR Am J Neuroradiol 20:3913991999

17

Iijima APiotin MMounayer CSpelle LWeill AMoret J: Endovascular treatment with coils of 149 middle cerebral artery berry aneurysms. Radiology 237:6116192005

18

International Stroke Trial Collaborative Group: The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet 349:156915811997

19

Jennett BBond M: Assessment of outcome after severe brain damage. Lancet 1:4804841975

20

Johnston SCDowd CFHigashida RTLawton MTDuckwiler GRGress DR: Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39:1201252008

21

Kai YHamada JMorioka MYano SNakamura HMakino K: Re-treatment of patients with embolized ruptured intracranial aneurysms. Surg Neurol 70:3783852008

22

Koebbe CJVeznedaroglu EJabbour PRosenwasser RH: Endovascular management of intracranial aneurysms: current experience and future advances. Neurosurgery 59:5 Suppl 3S93S1132006

23

Koivisto TVanninen RHurskainen HSaari THernesniemi JVapalahti M: Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke 31:236923772000

24

Kuether TANesbit GMBarnwell SL: Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience. Neurosurgery 43:101610251998

25

Lefkowitz MAGobin YPAkiba YDuckwiler GRMurayama YGuglielmi G: Balloon-assisted Guglielmi detachable coiling of wide-necked aneurysma: Part II—clinical results. Neurosurgery 45:5315381999

26

McDougall CGHalbach VVDowd CFHigashida RTLarsen DWHieshima GB: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:3933991996

27

Molyneux AKerr RStratton ISandercock PClarke MShrimpton J: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:126712742002

28

Molyneux AJKerr RSBirks JRamzi NYarnold JSneade M: Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 8:4274332009

29

Molyneux AJKerr RSYu LMClarke MSneade MYarnold JA: International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:8098172005

30

Mordasini PSchroth GGuzman RBarth ASeiler RWRemonda L: Endovascular treatment of posterior circulation cerebral aneurysms by using Guglielmi detachable coils: a 10-year single-center experience with special regard to technical development. AJNR Am J Neuroradiol 26:173217382005

31

Moret JCognard CWeill ACastaings LRey A: [Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases.]. J Neuroradiol 24:30441997. (Fr)

32

Murayama YNien YLDuckwiler GGobin YPJahan RFrazee J: Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 98:9599662003

33

Murayama YViñuela FDuckwiler GRGobin YPGuglielmi G: Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg 90:2072141999

34

Pandey ASKoebbe CRosenwasser RHVeznedaroglu E: Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery 60:6266372007

35

Raymond JGuilbert FWeill AGeorganos SAJuravsky LLambert A: Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:139814032003

36

Raymond JRoy DBojanowski MMoumdjian RL'Espérance G: Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 86:2112191997

37

Renowden SABenes VBradley MMolyneux AJ: Detachable coil embolisation of ruptured intracranial aneurysms: a single center study, a decade experience. Clin Neurol Neurosurg 111:1791882009

38

Ries TSiemonsen SThomalla GGrzyska UZeumer HFiehler J: Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. AJNR Am J Neuroradiol 28:175517612007

39

Schaafsma JDSprengers MEvan Rooij WJSluzewski MMajoie CBWermer MJ: Long-term recurrent subarachnoid hemorrhage after adequate coiling versus clipping of ruptured intracranial aneurysms. Stroke 40:175817632009

40

Sluzewski Mvan Rooij WJBeute GNNijssen PC: Late rebleeding of ruptured intracranial aneurysms treated with detachable coils. AJNR Am J Neuroradiol 26:254225492005

41

Sluzewski Mvan Rooij WJRinkel GJWijnalda D: Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology 227:7207242003

42

Sohn MJByrne JV: A computerised relational database for auditing endovascular treatment of patients with intracranial aneurysms. Neuroradiology 42:7627652000

43

Solander SUlhoa AViñuela FDuckwiler GRGobin YPMartin NA: Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils. J Neurosurg 90:8578641999

44

Thornton JDebrun GMAletich VABashir QCharbel FTAusman J: Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 50:2392502002

45

Tsutsumi KUeki KMorita AUsui MKirino T: Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: results of long-term follow-up angiography. Stroke 32:119111942001

46

Tsutsumi KUeki KUsui MKwak SKirino T: Risk of recurrent subarachnoid hemorrhage after complete obliteration of cerebral aneurysms. Stroke 29:251125131998

47

van der Schaaf ICVelthuis BKWermer MJMajoie CWitkamp Tde Kort G: New detected aneurysms on follow-up screening in patients with previously clipped intracranial aneurysms: comparison with DSA or CTA at the time of SAH. Stroke 36:175317582005

48

Viñuela FDuckwiler GMawad M: Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:4754821997

49

Wermer MJGreebe PAlgra ARinkel GJ: Incidence of recurrent subarachnoid hemorrhage after clipping for ruptured intracranial aneurysms. Stroke 36:239423992005

50

Willinsky RAPeltz Jda Costa LAgid RFarb RIterBrugge KG: Clinical and angiographic follow-up of ruptured intracranial aneurysms treated with endovascular embolization. AJNR Am J Neuroradiol 30:103510402009

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 92 92 46
Full Text Views 152 152 8
PDF Downloads 102 102 5
EPUB Downloads 0 0 0

PubMed

Google Scholar