Is 3 years adequate for tracking completely occluded coiled aneurysms?

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OBJECTIVE

The authors conducted a study to ascertain the long-term durability of coiled aneurysms completely occluded at 36 months’ follow-up given the potential for delayed recanalization.

METHODS

In this retrospective review, the authors examined 299 patients with 339 aneurysms, all shown to be completely occluded at 36 months on follow-up images obtained between 2011 and 2013. Medical records and radiological data acquired during the extended monitoring period (mean 74.3 ± 22.5 months) were retrieved, and the authors analyzed the incidence of (including mean annual risk) and risk factors for delayed recanalization.

RESULTS

A total of 5 coiled aneurysms (1.5%) occluded completely at 36 months showed recanalization (0.46% per aneurysm-year) during the long-term surveillance period (1081.9 aneurysm-years), 2 surfacing within 60 months and 3 developing thereafter. Four showed minor recanalization, with only one instance of major recanalization. The latter involved the posterior communicating artery as an apparent de novo lesion, arising at the neck of a firmly coiled sac, and was unrelated to coil compaction or growth. Additional embolization was undertaken. In a multivariate analysis, a second embolization for a recurrent aneurysm (HR = 22.088, p = 0.003) independently correlated with delayed recanalization.

CONCLUSIONS

Almost all coiled aneurysms (98.5%) showing complete occlusion at 36 months postembolization proved to be stable during extended observation. However, recurrent aneurysms were predisposed to delayed recanalization. Given the low probability yet seriousness of delayed recanalization and the possibility of de novo aneurysm formation, careful monitoring may be still considered in this setting but at less frequent intervals beyond 36 months.

ABBREVIATIONS DNIA = de novo intracranial aneurysm; SAH = subarachnoid hemorrhage; TOF = time-of-flight.

Article Information

Correspondence Young Dae Cho: Seoul National University Hospital, Seoul, Korea. aronnn@naver.com.

ACCOMPANYING EDITORIAL DOI: 10.3171/2019.6.JNS191348.

INCLUDE WHEN CITING Published online August 16, 2019; DOI: 10.3171/2019.5.JNS183651.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Schematic of study design. F/U = follow-up. Figure is available in color online only.

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    Representative patient with delayed recanalization of coiled aneurysm. A: Preembolization angiogram of a posterior communicating artery aneurysm. B: Postembolization angiogram demonstrating successful occlusion. C: Completely occluded aneurysm on follow-up MR angiogram (36 months). D: CT image showing SAH at 48 months postembolization. E: De novo aneurysm (major recanalization) at the neck of firmly occluded coiled sac, shown by conventional angiography. F: Repeat embolization for the recurred aneurysm.

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