Intracranial aneurysms treated with Guglielmi detachable coils: long-term imaging follow-up with contrast-enhanced magnetic resonance angiography

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Object

The aim of this study was to assess the long-term results of intracranial aneurysms treated with Guglielmi detachable coils (GDCs) with the aid of contrast-enhanced magnetic resonance (MR) angiography.

Methods

Between January 1998 and August 2001, 92 patients with 92 aneurysms treated by endovascular coiling with GDCs underwent contrast-enhanced MR angiography. These patients underwent long-term follow-up (range 32–78 months, mean 42.1 ± 11.9 months [standard deviation]) after endovascular treatment. All images were compared with digital subtraction angiograms and contrast-enhanced MR angiograms that had been obtained during the short-term follow-up (range 5–25 months, mean 13 ± 5.1 months after treatment). The MR angiograms were analyzed independently by 2 senior radiologists. Findings were assigned to 1 of 3 categories: complete obliteration (Class 1), residual neck (Class 2), or residual aneurysm (Class 3).

Results

Of 92 contrast-enhanced MR angiograms obtained at the long-term follow-up, complete obliteration of the aneurysm was noted in 57 patients (Class 1), a residual neck was seen in 22 (Class 2), and a residual aneurysm was observed in 13 (Class 3). One patient experienced aneurysm rehemorrhaging during the follow-up period. The comparison of short- and long-term follow-up angiograms demonstrated a change in aneurysm classification in 7 patients (7.6%), including 4 that progressed from Class 1 to Class 2 and 3 from Class 2 to Class 3. However, 4 (14.2%) of the 28 long-term recurrences were not detected on the short-term control images.

Conclusions

Long-term follow-up with contrast-enhanced MR angiography after selective embolization of intracranial aneurysms can identify late aneurysm recanalization that is undetected at short-term follow-up.

Abbreviations used in this paper: DS = digital subtraction; GDC = Guglielmi detachable coil; MR = magnetic resonance; TOF = time-of-flight.

Article Information

Address correspondence to: Jean-Yves Gauvrit, M.D., Service de Neuroradiologie, Hôpital Roger Salengro Centre Hospitalier Régional Universitaire de Lille, Boulevard Emile Laine, 59037 Lille Cédex, France. email: jygauvrit@chru-lille.fr.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flowchart summarizing the patients treated in this series.

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    Block diagram showing the aneurysm classification in 3 classes at the first (continuous rectangle) and second (dotted rectangle) MR angiography.

  • View in gallery

    A: Digital subtraction angiogram of the right carotid artery just before treatment, showing a 6-mm aneurysm of the anterior communicating artery. The treatment was complete. B and C: Frontal head view DS angiogram (B) of the right internal carotid artery and contrast-enhanced MR angiogram (C) obtained at 11 months after treatment, showing absence of recanalization. D: Contrast-enhanced MR angiogram obtained at 35 months, demonstrating a residual neck (arrow, Class 2).

  • View in gallery

    A: Digital subtraction angiogram of the vertebral artery before treatment of a 3-mm aneurysm of the basilar artery. B: Frontal head view DS angiogram obtained at 15 months, showing opacification of a residual neck (arrow, Class 2). C: Contrast-enhanced MR angiography with coronal maximum intensity projection reconstruction at 48 months, demonstrating a residual aneurysm (arrow, Class 3). Retreatment was performed.

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