Late adverse events in coiled ruptured aneurysms with incomplete occlusion at 6-month angiographic follow-up.
OBJECTIVE
Patients with coiled ruptured aneurysms with incomplete occlusion at 6 months are not only at risk for rebleed during further follow-up but also for complications of angiographic follow-up and retreatment, and for progressive mass effect by uncontrollable aneurysm growth. We assessed the frequency and outcome of all these possible aneurysm-related events in 124 patients with incompletely occluded aneurysms at 6 months during a follow-up of 419 patient-years.


METHODS
Between 1994 and 2007, 901 ruptured aneurysms were coiled and 713 (79%) had 6-month angiographic follow-up, of which 124 were incompletely occluded (17%). These 124 patients were followed for a mean of 41 months (median, 30 months; range, 1-150 months).


RESULTS
During follow-up, 307 angiograms were obtained without complications. Of 124 aneurysms, 88 were retreated (71%). Fifteen aneurysms were retreated more than once. Altogether, 124 additional treatments were performed, and no complications occurred (0%; 95% CI, 0.0-3.6%). Four aneurysms rebled, causing death in 2 patients. Another 4 patients experienced progressive mass effect by growth of the coiled aneurysm, leading to death in 1. The annual event rate was 1.9%, the annual mortality was 0.7%, and the annual rebleed rate was 1.0% (8, 3, and 4 in 419 patient-years).


CONCLUSIONS
In this study of patients with coiled ruptured aneurysms with incomplete occlusion at 6 months, a strategy of imaging follow-up and retreatment when possible leads to a low incidence of serious adverse events. Rebleeding and progressive mass effect of the aneurysm were responsible for these events, not complications from additional treatment or angiographic follow-up.
Ferns
S P
SP
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. S.P.Ferns@amc.uva.nl
Majoie
C B L M
CB
Sluzewski
M
M
van Rooij
W J
WJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019233:Retreatment / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome