title: Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment.
abstract: OBJECTIVE
  Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment.
  
  
  METHODS
  Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images.
  
  
  RESULTS
  Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment.
  
  
  CONCLUSIONS
  The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania;
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Cory D
authors.initials: CD
authors.lastname: Bovenzi
authors.forename: Vismay
authors.initials: V
authors.lastname: Thakkar
authors.forename: Jeremy
authors.initials: J
authors.lastname: Dressler
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Sonia
authors.initials: S
authors.lastname: Teufack
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Richard
authors.initials: R
authors.lastname: Dalyai
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D015901:Angiography, Digital Subtraction; D002405:Catheterization, Central Venous / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies
keywords: DSA = digital subtraction angiography; angiography; coil therapy; interventional neurosurgery; intracranial aneurysm; recurrence; vascular disorders