Extended monitoring of re-coiled cerebral aneurysms after initial postcoiling recanalization: Safety and durability of repeat coil embolization - 09/02/24
Highlight |
• | Repeat embolization for recurred aneurysm is not favored due to intrinsic technical challenge, and the projected durability of re-coiled aneurysms remains unclear. |
• | Multivariable Cox regression analysis linked re-recanalization to initial saccular neck width and ADPKD. |
• | Stent implantation and successful occlusion at second coiling were protective against further recanalization. |
• | The more recent the second embolization was performed, the lower the risk of further recurrence. |
• | Repeat coil embolization is a safe therapeutic option for recanalized cerebral aneurysms. |
Abstract |
Purpose |
In the endovascular era, postcoiling recanalization of cerebral aneurysms is occurring with greater frequency. Repeat coiling is usually done to prevent rebleeding, although long-term outcomes of re-embolization have yet to be adequately investigated. The present study was undertaken to assess clinical and radiographic outcomes of re-embolization in recanalized aneurysms, focusing on procedural safety, efficacy, and durability.
Method |
In this retrospective review, we examined 308 patients with 310 recurrent aneurysms. All lesions were re-coiled, once major recanalization (after initial coil embolization) was established. Medical records and radiologic data amassed during extended follow-up were then subject to review. Cox proportional hazards regression analysis was undertaken to identify risk factors for subsequent recurrence.
Result |
During a lengthy follow-up (mean, 40.2 ± 33.0 months), major recanalization developed again in 87 aneurysms (28.1%). Multivariable Cox regression analysis linked re-recanalization to initial saccular neck width (p=.003) and autosomal dominant polycystic kidney disease (ADPKD; p<.001). Stent implantation (p=.038) and successful occlusion at second coiling (p=.012) were protective against later recanalization in this setting. The more recent the second embolization was performed, the lower the risk of further recurrence (p=.023). Procedure-related complications included asymptomatic thromboembolism (n = 9), transient ischemic neurologic deficits (n = 2), procedural bleeding (n = 1), and coil migration (n = 1), but there were no residual effects or deaths.
Conclusion |
Repeat coil embolization is a safe therapeutic option for recanalized cerebral aneurysms. Wide-necked status and ADPKD emerged as risks for subsequent recanalization, whereas successful occlusion and stent implantation seemed to reduce the likelihood of recurrence after re-embolization procedures.
Le texte complet de cet article est disponible en PDF.Keywords : Aneurysm, Coil, Embolization, Recanalization, Durability, Retreatment
Abbreviations : UIA, RIA, DSA, TOF MRA, mRS, ADPKD
Plan
Vol 51 - N° 1
P. 59-65 - février 2024 Retour au numéro
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