Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding.
OBJECTIVE
During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully treated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting patients against rebleeding.


METHODS
Patients were followed for 6 to 65 months (median 22.3 months) by clinical review, angiography performed at 6 months posttreatment, and annual questionnaires. Stable angiographic occlusion was evident in 86.4% of small and 85.2% of large aneurysms with recurrent filling in 38 (14.7%) of 259 aneurysms. Rebleeding was caused by aneurysm recurrence in four patients (between 11 and 35 months posttreatment) and by rupture of a coincidental untreated aneurysm in one patient. Annual rebleeding rates were 0.8% in the 1st year, 0.6% in the 2nd year, and 2.4% in the 3rd year after aneurysm embolization, with no rebleeding in subsequent years. Rebleeding occurred in three (7.9%) of 38 recurrent aneurysms and in one (0.4%) of 221 aneurysms that appeared stable on angiography.


CONCLUSIONS
Periodic follow-up angiography after coil embolization is recommended to identify aneurysm recurrence and those patients at a high risk of late rebleeding.
Byrne
J V
JV
University Department of Radiology, The Radcliffe Infirmary National Health Service Trust, Oxford, England, United Kingdom. james.byrne@radiology.ox.ac.uk
Sohn
M J
MJ
Molyneux
A J
AJ
Chir
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000209:etiology / Q000628:therapy*; D001488:Basilar Artery / Q000473:pathology; D002340:Carotid Artery Diseases / Q000628:therapy; D002531:Cerebellum / Q000098:blood supply; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000473:pathology; D012008:Recurrence; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000473:pathology