Is long-term follow-up of adequately coil-occluded ruptured cerebral aneurysms always necessary? A single-center study of recurrences after endovascular treatment.
OBJECTIVE
Aneurysm recurrence following coil occlusion is well recognized. However, there is controversy as to how long these patients should be followed up after coiling to detect reopening. We aimed to identify the rate of late reopening and the risk factors for reopening in a large single-center cohort of ruptured aneurysms that appeared adequately occluded at 6 months. We also aimed to assess whether rates of recurrence have altered over time with improving coil and angiographic technology.


METHODS
Patients treated between 1996 and 2010 were assessed and those with both 6-month initial and subsequent long-term follow-up with either digital subtraction angiography or magnetic resonance angiography were included. Aneurysms were stratified by features such as size, neck width, anatomical location and time of treatment: 1996-2005 (cohort 1) and 2006-2010 (cohort 2). ORs for risk of recurrence were calculated for aneurysm features and rates of recurrence in each cohort were compared using a χ(2) test.


RESULTS
437 patients with 458 adequately occluded aneurysms at 6 months had mean long-term follow-up of 31 months; 57 (12.4%) were large (≥ 10 mm) and 104 (22.7%) were wide-necked (>4 mm). Nine aneurysms (2%) showed significant late anatomical deterioration whereby retreatment was considered or undertaken. The risk was greater for large aneurysms (≥ 10 mm) (OR 15.61, 95% CI 3.79 to 64.33, p=0.0001) or wide-necked aneurysms (>4 mm) (OR 12.70, 95% CI 2.60 to 62.13, p=0.0017). The frequency of significant late anatomical deterioration and retreatment was also less common in those treated in cohort 2 (p<0.05). No completely occluded aneurysm at 6 months demonstrated significant late recurrence.


CONCLUSIONS
Most aneurysms adequately occluded at 6 months did not show evidence of late recurrence. Large and wide-neck aneurysms are, however, at greater risk of later recurrence.
Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Alex M
AM
Mortimer
Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Hannah
H
Marsh
Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Katherine
K
Klimczak
Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Dhiraj
D
Joshi
Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Helena
H
Barton
Department of Neurosurgery, Fenchay Hospital, Bristol, UK.
Richard J
RJ
Nelson
Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Marcus D
MD
Bradley
Department of Neuroradiology, Frenchay Hospital, Bristol, UK.
Shelley A
SA
Renowden
D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000628:therapy*; D002985:Clinical Protocols / Q000592:standards*; D057510:Endovascular Procedures / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D012307:Risk Factors; D060205:Therapeutic Occlusion / Q000592:standards*; D055815:Young Adult
Aneurysm; Angiography; Intervention; Magnetic Resonance Angiography; Subarachnoid