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      Cerebral Aneurysm Sac Growth as the Etiology of Recurrence After Successful Coil Embolization

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          Abstract

          Coil compaction is thought to be the main mechanism for recurrence in cerebral aneurysms with previously successful coil embolization. We hypothesize that sac growth may be equally or more important. The objective was to study the relative roles of coil compaction and sac growth as explanations for aneurysm recurrence requiring retreatment in a study population using quantitative 3D image processing methods.

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          Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils.

          Jean Raymond, François Guilbert, Alain Weill … (2003)
          Our aim in this study was to assess the incidence and determining factors of angiographic recurrences after endovascular treatment of aneurysms. A retrospective analysis of all patients with selective endosaccular coil occlusion of intracranial aneurysms prospectively collected from 1992 to 2002 was performed. There were 501 aneurysms in 466 patients (mean+/-SD age, 54.20+/-12.54 years; 74% female). Aneurysms were acutely ruptured (54.1%) or unruptured (45.9%). Mean+/-SD aneurysm size was 9.67+/-5.91 mm with a 4.31+/-1.97-mm neck. The most frequent sites were basilar bifurcation (27.7%) and carotid ophthalmic (18.0%) aneurysms. Recurrences were subjectively divided into minor and major (ideally necessitating re-treatment). The most significant predictors of angiographic recurrence were determined by logistic regression. These results were confirmed by chi2, t tests, or ANOVAs followed, when appropriate, by Tukey's contrasts. Short-term ( 1 year) follow-up angiograms, in 277 (55%), for a total of 383 (76.5%) followed up. Recurrences were found in 33.6% of treated aneurysms that were followed up and that appeared at a mean+/-SD time of 12.31+/-11.33 months after treatment. Major recurrences presented in 20.7% and appeared at a mean of 16.49+/-15.93 months. Three patients (0.8%) bled during a mean clinical follow-up period of 31.32+/-24.96 months. Variables determined to be significant predictors (P or =10 mm, treatment during the acute phase of rupture, incomplete initial occlusions, and duration of follow-up. Long-term monitoring of patients treated by endosaccular coiling is mandatory.
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            International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial

            Andrew J. Molyneux (2002)
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              Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience.

              Neil Martin, Y. Pierre Gobin, J Frazee … (2003)
              The authors report on their 11 years' experience with embolization of cerebral aneurysms using Guglielmi Detachable Coil (GDC) technology and on the attendant anatomical and clinical outcomes. Since December 1990, 818 patients harboring 916 aneurysms were treated with GDC embolization at University of California at Los Angeles Medical Center. For comparative purposes, the patients were divided into two groups: Group A included their initial 5 years' experience with 230 patients harboring 251 aneurysms and Group B included the later 6 years' experience with 588 patients harboring 665 aneurysms. Angiographically demonstrated complete occlusion was achieved in 55% of aneurysms and a neck remnant was displayed in 35.4% of lesions. Incomplete embolization was performed in 3.5% of aneurysms, and in 5% occlusion was attempted unsuccessfully. A comparison between the two groups revealed a higher complete embolization rate in patients in Group B compared with that in Group A patients (56.8 and 50.2%, respectively). The overall morbidity/mortality rate was 9.4%. Angiographic follow ups were obtained in 53.4% of cases of aneurysms, and recanalization was exhibited in 26.1% of aneurysms in Group A and 17.2% of those in Group B. The overall recanalization rate was 20.9%. Note that recanalization was related to the size of the dome and neck of the aneurysm. Overall incidence of delayed aneurysm rupture was 1.6%, a rate that improved in the past 5 years to 0.5%. Ten of 12 delayed ruptures occurred in large or giant aneurysms. The clinical and postembolization outcomes in patients treated with the GDC system have improved in the past 5 years. Aneurysm recanalization, however, is still a major limitation of current GDC therapy. Follow-up angiography is mandatory after GDC embolization of cerebral aneurysms. Further technical and device improvements are mandatory to overcome current GDC limitations.
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                Author and article information

                Journal
                Title: Stroke
                Abbreviated Title: Stroke
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0039-2499
                ISSN (Electronic): 1524-4628
                Publication date Created: March 2012
                Publication date (Print): March 2012
                Volume: 43
                Issue: 3
                Pages: 866-868
                Affiliations
                [1 ]From the Department of Neurosurgery, Carver College of Medicine (D.M.H., K.B.M., D.K.K.), and Department of Biomedical Engineering, College of Engineering (A.I.N., A.L.H., M.L.R.), University of Iowa, Iowa City, IA.
                Article
                DOI: 10.1161/STROKEAHA.111.637827
                PMC ID: 3472954
                PubMed ID: 22180247
                SO-VID: 6254d5d3-24c3-4cab-9efb-d842496bf542
                Copyright © © 2012
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