Long-term follow-up of intra-aneurysmal coil embolization for unruptured paraclinoid aneurysms.
OBJECTIVE
The selection of therapeutic modalities, including endovascular coil embolization and surgical clipping, for management of unruptured paraclinoid aneurysms, remains controversial. Detailed long-term outcome data for endovascular coil embolization of unruptured paraclinoid  aneurysms are still lacking. Thus, we evaluated the safety and efficacy of coil embolization of unruptured paraclinoid aneurysms.


METHODS
From January 1998 to July 2010, 138 patients underwent endovascular coiling for 140 unruptured paraclinoid aneurysms. Their medical records and  radiologic images were reviewed retrospectively.


RESULTS
Complications occurred in 5·7% of 140 procedures and the morbidity rate was 0·7%. Of the 140 unruptured paraclinoid aneurysms, a total of 111 aneurysms underwent follow-up imaging evaluation at 2 years or more,  or showing reopening on imaging studies within 2 years (65·6±37·2 months). Multivariate analysis revealed two predictors for reopening of the aneurysms: a maximum diameter of aneurysms and a dome/neck ratio of aneurysms (P<0·05). Reopening rates of aneurysms  with maximum sizes of <8, 8-10, and >10 mm were 1%, 25%, and 75%, respectively. Reopening rates were significantly different among the three groups (P<0·05). In aneurysms with a maximum diameter of 8-10 mm, there was a significant difference of dome/neck  ratios between the presence and absence of reopened aneurysms (P<0·05).


CONCLUSIONS
The results indicate that endovascular coil embolization is a safe and effective treatment modality in selected patients with unruptured paraclinoid aneurysms. Consideration of the  aneurysm size and the dome/neck ratio could assist in the selection of therapeutic modalities for these aneurysms.
Department of Neurosurgery, Brain Research Institute, University of Niigata, Japan. sorimachi@tokai-u.jp
Takatoshi
T
Sorimachi
Yasushi
Y
Ito
Kenichi
K
Morita
Yasushi
Y
Jimbo
Kazuhiko
K
Nishino
Osamu
O
Sasaki
Tetsuo
T
Koike
Takashi
T
Kumagai
Yukihiko
Y
Fujii
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001807:Blood Vessel Prosthesis; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome