Related Experiment Video
Updated: Jun 14, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Long-term prospective follow-up of intracranial aneurysms treated with endovascular coiling using contrast-enhanced
J J S Shankar1, Cheemun Lum, N Parikh
1Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.
Insights
Contrast-enhanced MR angiography (CE-MRA) effectively monitors intracranial aneurysms after coiling. This noninvasive method allows frequent follow-up, detecting recanalization and changes in aneurysm obliteration patterns.
Area of Science:
- Neurosurgery
- Radiology
- Vascular Imaging
Background:
- Catheter angiography is the gold standard for intracranial aneurysm follow-up.
- Contrast-enhanced MR angiography (CE-MRA) is increasingly used for evaluating aneurysm recanalization.
Purpose of the Study:
- To assess the feasibility and utility of a CE-MRA protocol for monitoring patients with intracranial aneurysms treated with endovascular coiling.
Main Methods:
- 134 aneurysms in 124 patients treated with detachable coils were followed using CE-MRA at 3 months, 15 months, and 3-5 years.
- Findings were categorized into complete obliteration, residual neck, or residual aneurysm.
Main Results:
- Initial CE-MRA showed 50% complete obliterations, 41.79% residual necks, and 5.97% residual aneurysms.
- Over follow-up (214 patient-years), 41.79% of aneurysms showed changes, primarily recanalization (47 cases).
- Most changes remained stable; only 8.21% required re-treatment.
Conclusions:
- CE-MRA is a feasible and useful noninvasive tool for routine follow-up of coiled intracranial aneurysms.
- CE-MRA enables frequent monitoring and can reveal more detailed information about aneurysm neck or sac filling compared to DSA.
Background And Purpose:
Catheter angiography has been the criterion standard for follow-up evaluation of coiled intracranial aneurysms. In our center, CE-MRA has been used to evaluate aneurysm recanalization. Our aim was to investigate the feasibility and usefulness of a CE-MRA protocol for following patients with intracranial aneurysms treated with endovascular coiling.
Materials And Methods:
From September 2003 to December 2006, 134 aneurysms were treated by endovascular coiling in 124 patients by using detachable coils. These patients were followed with CE-MRA at 3 months, 15 months, and 3 and 5 years. MRAs were analyzed by 2 interventional neuroradiologists. Findings were assigned to 3 categories: complete obliteration (class 1), residual neck (class 2), and residual aneurysm (class 3).
Results:
Initially, CE-MRA demonstrated 67 (50%) complete obliterations (class 1), 57 (41.79%) residual necks (class 2), and 8 (5.97%) residual aneurysms (class 3). No patient experienced rebleed during the follow-up period. A total of 214 patient-years of follow-up were obtained (range, 0-53 months). Two (1.49%) patients died after the follow-up, and 11 (8.21%) patients were lost to follow-up. On follow-up, 76 (56.72%) patients showed stable results. Fifty-six (41.79%) aneurysms showed change in their obliteration pattern. Of these 56, 47 demonstrated recanalization and 9 (6.72%) showed further obliteration. Most of the aneurysms that showed change in their obliteration remained stable on follow-up. Only 11 (8.21% of the total and 23.4% of those who showed recanalization) patients underwent recoiling or clipping.
Conclusions:
CE-MRA can be used in routine practice to follow-up aneurysm recanalization noninvasively. CE-MRA permits close-interval follow-up and may show more filling of the aneurysm neck or sac than DSA.
Related Concept Videos
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:26Aneurysm III: Interprofessional Care
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:22Aneurysm IV: Nursing Management