Defining the risk of retreatment for aneurysm recurrence or residual after initial treatment by endovascular coiling: a multicenter study.
OBJECTIVE
Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling.


METHODS
Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days).


RESULTS
Retreatment mortality was 0.85% per procedure and 0.96% per patient. Treatment-related rates were 0.32% per patient (0.28% per procedure) for permanent or temporary major disability; 1.29% for permanent minor disability (1.14% per procedure); and 1.61% for temporary minor disability (1.42% per procedure). Total risk for death or permanent major disability was 1.28% per patient and 1.13% per procedure.


CONCLUSIONS
Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.
Ringer
Andrew J
AJ
Department of Neurosurgery, University of Cincinnati Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio 45267-0515, USA. editor@mayfieldclinic.com
Rodriguez-Mercado
Rafael
R
Veznedaroglu
Erol
E
Levy
Elad I
EI
Hanel
Ricardo A
RA
Mericle
Robert A
RA
Lopes
Demetrius K
DK
Lanzino
Giuseppe
G
Boulos
Alan S
AS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects / Q000706:statistics & numerical data*; D011859:Radiography; D012086:Reoperation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D055815:Young Adult