Clinical and angiographic long-term follow-up of completely coiled intracranial aneurysms using endovascular technique

Clinical article

Dae Seob Choi M.D. 1 , Mun Chul Kim M.D. 2 , Seon Kyu Lee M.D., Ph.D. 3 , Robert A. Willinsky M.D., F.R.C.P.C. 4 , and Karel G. Terbrugge M.D., F.R.C.P.C. 4
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  • 1 Department of Radiology, Gyeongsang National University School of Medicine, Jinju;
  • 2 Department of Neurosurgery, Pohang St. Mary's Hospital, Pohang, South Korea;
  • 3 Department of Interventional Neuroradiology, Lahey Clinic Medical Center, Burlington, Massachusetts; and
  • 4 Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Canada
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Object

The anatomical evolution and clinical outcome of completely coiled intracranial aneurysms after endovascular embolization have rarely been studied separately. From their prospective database, the authors reviewed follow-up angiography and clinical outcome of 87 patients whose aneurysms were designated as 100% obliterated on immediate postembolization angiography.

Methods

Ninety-one aneurysms (56 ruptured and 35 unruptured) in 87 patients were included in this study. Clinical outcome was evaluated using the Glasgow Outcome Scale. Follow-up angiographic findings were assessed and categorized as 1 of the following: no recanalization, recanalization with a neck remnant, or recanalization with a body remnant. For statistical analysis, the recanalization rate was correlated with: clinical presentation; the largest aneurysm diameter, aneurysm neck size, and dome-to-neck ratio; aneurysm location; and use of special techniques such as usage of a surface modified coil, balloon remodeling technique, or stent.

Results

At the latest clinical evaluation (mean 34.3 months), 81 (93.1%) of the 87 patients (91 aneurysms) had good clinical outcomes (Glasgow Outcome Scale Score 5). The procedure-related morbidity rate (permanent neurological deficit) was 2.3% (2 of 87), and there were no procedure-related deaths. On the latest follow-up angiography (mean 26.4 months), the recanalization rate was 26.4% (24 of 91 aneurysms): 16 (17.6%) with neck remnants and 8 (8.8%) with body remnants. The neck size of the recanalized aneurysms was statistically significantly larger than that of the nonrecanalized aneurysms (p = 0.006), and aneurysms with wide necks (≥4 mm) had a higher recanalization rate than those with a narrow neck (< 4 mm) (p = 0.002). There was no bleeding after endovascular treatment during the follow-up period.

Conclusions

Completely coiled aneurysms after endovascular embolization demonstrated good clinical outcome, and there was no bleeding episode after endovascular treatment; however, there was a relatively high recanalization rate.

Abbreviations used in this paper: ACoA = anterior communicating artery; ATECO = auto-triggered elliptical-centric-ordered; BA = basilar artery; DS = digital subtraction; GOS = Glasgow Outcome Scale; ICA = internal carotid artery; MCA = middle cerebral artery; SAH = subarachnoid hemorrhage.

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Contributor Notes

Address correspondence to: Seon Kyu Lee, M.D., Ph.D., Department of Radiology, Lahey Clinic Medical Center, Burlington, Massachusetts 01805. email: seonkyu.lee@lahey.org.

Please include this information when citing this paper: published online April 10, 2009; DOI: 10.3171/2008.12.JNS08768.

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