Does angiographic surveillance pose a risk in the management of coiled intracranial aneurysms? A multicenter study of 2243 patients.
OBJECTIVE
Endovascular treatment of intracranial aneurysms is a less invasive alternative than surgical repair. However, the higher risk of recurrence after coiling necessitates regular angiographic surveillance, which has associated risks. To date, the risk of surveillance angiography has not been quantified in patients with intracranial aneurysms treated by endovascular embolization.


METHODS
Angiograms performed for the surveillance of coiled intracranial aneurysms in patients treated at 8 institutions were recorded prospectively. Of 3086 patients eligible for surveillance angiography according to each institution's protocol during the study period, 2243 patients (72.7%) underwent this procedure. Data were reviewed retrospectively, including the results of each angiogram, angiographic complications, and morbidity resulting from the procedure. Morbidity was classified as major (modified Rankin Scale score >or=3) or minor (modified Rankin Scale score <3) and as temporary (<30 days) or permanent (>or=30 days).


RESULTS
Of 2814 diagnostic angiograms performed, 12 resulted in complications, including 1 (0.04%) permanent major morbidity, 2 (0.07%) temporary major morbidities, and 9 (0.32%) temporary minor morbidities; 6 of these were access site complications). No mortality or permanent minor morbidity was noted.


CONCLUSIONS
In this study, routine angiographic surveillance after endovascular treatment of aneurysms has a very low complication rate (0.43%). Incorporating these initial findings with the rate and risk of recurrent treatment or the risk of hemorrhage after coiling will provide a more accurate estimate of the global long-term risk of aneurysm coiling.
Ringer
Andrew J
AJ
Department of Neurosurgery, The Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0515, USA. editor@mayfieldclinic.com
Lanzino
Giuseppe
G
Veznedaroglu
Erol
E
Rodriguez
Rafael
R
Mericle
Robert A
RA
Levy
Elad I
EI
Hanel
Ricardo A
RA
Lopes
Demetrius K
DK
Boulos
Alan S
AS
D002533:Cerebral Angiography / Q000009:adverse effects* / Q000706:statistics & numerical data*; D016208:Databases, Factual / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors