Long-term results of ruptured cerebral aneurysms embolized in acute stage with interlocking detachable coils

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=l) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage. Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90-95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm. In all 5 cases with partial occlusion, follow-up angiograms taken 2-4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively. Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1. Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically. Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils. Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.