Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

Clinical article

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Object

Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment.

Methods

Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images.

Results

Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment.

Conclusions

The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.

Abbreviation used in this paper:DSA = digital subtraction angiography.
Article Information

Contributor Notes

Address correspondence to: Stavropoula I. Tjoumakaris, M.D., Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut St., 2nd Fl., Philadelphia, PA 19107. email: stavropoula.tjoumakaris@jefferson.edu.Please include this information when citing this paper: published online September 5, 2014; DOI: 10.3171/2014.7.JNS132433.
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References
  • 1

    Altman DG: Practical Statistics for Medical Research Boca Raton, FLChapman & Hall/CRC1999

  • 2

    Chalouhi NAli MSJabbour PMTjoumakaris SIGonzalez LFRosenwasser RH: Biology of intracranial aneurysms: role of inflammation. J Cereb Blood Flow Metab 32:165916762012

    • Search Google Scholar
    • Export Citation
  • 3

    Chalouhi NDumont ASHasan DTjoumakaris SGonzalez LFStarke RM: Is packing density important in stentassisted coiling?. Neurosurgery 71:3813872012

    • Search Google Scholar
    • Export Citation
  • 4

    Chalouhi NJabbour PGonzalez LFDumont ASRosenwasser RStarke RM: Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases. Neurosurgery 71:7857942012

    • Search Google Scholar
    • Export Citation
  • 5

    Chalouhi NJabbour PIbrahim IStarke RMYounes PEl Hage G: Surgical treatment of ruptured anterior circulation aneurysms: comparison of pterional and supraorbital keyhole approaches. Neurosurgery 72:4374422013

    • Search Google Scholar
    • Export Citation
  • 6

    Chalouhi NJabbour PSinghal SDrueding RStarke RMDalyai RT: Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 44:134813532013

    • Search Google Scholar
    • Export Citation
  • 7

    Chalouhi NJabbour PTjoumakaris SDumont ASChitale RRosenwasser RH: Single-center experience with balloonassisted coil embolization of intracranial aneurysms: safety, efficacy and indications. Clin Neurol Neurosurg 115:6076132013

    • Search Google Scholar
    • Export Citation
  • 8

    Chalouhi NStarke RMKoltz MTJabbour PMTjoumakaris SIDumont AS: Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes. AJNR Am J Neuroradiol 34:198719922013

    • Search Google Scholar
    • Export Citation
  • 9

    Chalouhi NStarke RMYang SBovenzi CDTjoumakaris SHasan D: Extending the indications of flow diversion to small, unruptured, saccular aneurysms of the anterior circulation. Stroke 45:54582014

    • Search Google Scholar
    • Export Citation
  • 10

    Chalouhi NTjoumakaris SStarke RMGonzalez LFRandazzo CHasan D: Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke 44:215021542013

    • Search Google Scholar
    • Export Citation
  • 11

    Chitale RGonzalez LFRandazzo CDumont ASTjoumakaris SRosenwasser R: Single center experience with pipeline stent: feasibility, technique, and complications. Neurosurgery 71:6796912012

    • Search Google Scholar
    • Export Citation
  • 12

    Crobeddu ELanzino GKallmes DFCloft HJ: Review of 2 decades of aneurysm-recurrence literature, part 2: Managing recurrence after endovascular coiling. AJNR Am J Neuroradiol 34:4814852013

    • Search Google Scholar
    • Export Citation
  • 13

    Ferns SPSprengers MEvan Rooij WJvan Zwam WHde Kort GAVelthuis BK: Late reopening of adequately coiled intracranial aneurysms: frequency and risk factors in 400 patients with 440 aneurysms. Stroke 42:133113372011

    • Search Google Scholar
    • Export Citation
  • 14

    Gao BBaharoglu MIMalek AM: Angular remodeling in single stent-assisted coiling displaces and attenuates the flow impingement zone at the neck of intracranial bifurcation aneurysms. Neurosurgery 72:7397482013

    • Search Google Scholar
    • Export Citation
  • 15

    Hodgson TJCarroll TJellinek DA: Subarachnoid hemorrhage due to late recurrence of a previously unruptured aneurysm after complete endovascular occlusion. AJNR Am J Neuroradiol 19:193919411998

    • Search Google Scholar
    • Export Citation
  • 16

    Jabbour PChalouhi NTjoumakaris SGonzalez LFDumont ASRandazzo C: The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration. Neurosurgery 73:1131202013

    • Search Google Scholar
    • Export Citation
  • 17

    Jamous MANagahiro SKitazato KTTamura TKuwayama KSatoh K: Role of estrogen deficiency in the formation and progression of cerebral aneurysms. Part II: experimental study of the effects of hormone replacement therapy in rats. J Neurosurg 103:105210572005

    • Search Google Scholar
    • Export Citation
  • 18

    Lawson MFNewman WCChi YYMocco JDHoh BL: Stentassociated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69:5986042011

    • Search Google Scholar
    • Export Citation
  • 19

    McDonald JSCarter RELayton KFMocco JMadigan JBTawk RG: Interobserver variability in retreatment decisions of recurrent and residual aneurysms. AJNR Am J Neuroradiol 34:103510392013

    • Search Google Scholar
    • Export Citation
  • 20

    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

    • Search Google Scholar
    • Export Citation
  • 21

    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

    • Search Google Scholar
    • Export Citation
  • 22

    Naggara ONWhite PMGuilbert FRoy DWeill ARaymond J: Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology 256:8878972010

    • Search Google Scholar
    • Export Citation
  • 23

    Piotin MBlanc RSpelle LMounayer CPiantino RSchmidt PJ: Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41:1101152010

    • Search Google Scholar
    • Export Citation
  • 24

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

    • Search Google Scholar
    • Export Citation
  • 25

    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

    • Search Google Scholar
    • Export Citation
  • 26

    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

    • Search Google Scholar
    • Export Citation
  • 27

    Tailor JGoetz PChandrashekar HStephen TSchiariti MGrieve J: Stability of ruptured intracranial aneurysms treated with detachable coils: is delayed follow-up angiography warranted?. Br J Neurosurg 24:4054092010

    • Search Google Scholar
    • Export Citation
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