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

Clinical article

R. Scooter Plowman M.Sc. 1 , Alison Clarke B.A. 1 , Mike Clarke B.A., D.Phil. 2 and James V. Byrne M.D., F.R.C.S., F.R.C.R. 1 , 3
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  • 1 Nuffield Department of Surgery, University of Oxford,
  • 2 United Kingdom Cochrane Centre, and
  • 3 Oxford Radcliffe Hospitals, National Health Service Trust, Oxford, United Kingdom
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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.

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Contributor Notes

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.

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