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Published on: September 8, 2023
Clinical and angiographic outcome in patients with completely occluded intracranial aneurysms by endovascular
Andrew R Xavier1, Abdelaal Abdelbaky, Mahmoud Rayes
1Department of Neurological Surgery, Wayne State University and the Detroit Medical Center, Detroit, Michigan 48201, USA. axavier@med.wayne.edu
Insights
Complete endovascular occlusion effectively treats intracranial aneurysms (IAs), but recanalization occurs in some cases, particularly large ones. Long-term outcomes show good clinical recovery, though further follow-up is needed.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Limited data exists on recanalization rates after complete coil occlusion of intracranial aneurysms (IAs).
- Assessing long-term clinical and angiographic outcomes of endovascularly treated IAs is crucial.
Purpose of the Study:
- To evaluate the rate of recanalization following complete coil occlusion of intracranial aneurysms (IAs).
- To present the long-term clinical and angiographic outcomes of completely occluded IAs treated via endovascular approach.
Main Methods:
- A 4-year retrospective review of patients with completely occluded IAs treated with coiling.
- Clinical assessment using the Glasgow Outcome Scale (GOS) and angiographic follow-up to categorize recanalization.
Main Results:
- 83 aneurysms in 74 patients were completely occluded; 20 showed recanalization (24%), with higher rates in large aneurysms (57%) vs. small (14%).
- Most patients (65/74) achieved good clinical recovery (GOS 5).
- Recanalization was more common with body remnants (15) than neck remnants (5).
Conclusions:
- Complete endovascular occlusion is effective in preventing IA bleeding.
- Recanalization remains a concern despite lower rates compared to subtotal occlusion.
- Longer follow-up studies are necessary to fully understand long-term outcomes.
Objective:
There are limited data about the rate of recanalization following complete coil occlusion. Long term clinical and angiographic outcome of completely occluded intracranial aneurysms (IAs) by the endovascular approach are presented.
Methods:
Over the course of 4 years, patients with IAs which were completely occluded by coiling at our institution were reviewed. Clinical and angiographic data were analyzed. The patients were clinically assessed using the Glasgow Outcome Scale (GOS). Follow-up angiographic findings were categorized as: stable aneurysm with no recanalization, recanalization with a neck remnant and recanalization with a body remnant.
Results:
83 aneurysms were identified in 74 patients (15 men and 59 women, average age 52.4 years) with complete occlusion post intervention. Treatment by coiling only was used in 73 aneurysms while stent assisted coiling was used in 10 cases. At the last angiographic follow-up (mean 16.3 months), 20 of the 83 aneurysms demonstrated various degrees of recanalization of which five had neck remnants and 15 had body remnants. The recanalization rate was significantly higher in large aneurysms (57%) compared with small aneurysms (14%). Clinically, 65 of the 74 patients showed good recovery (GOS score 5), eight had moderate disability (GOS score 4) and one was severely disabled (GOS score 3).
Conclusion:
Complete endovascular occlusion of IA is certainly effective in preventing aneurysmal bleeding. However, recanalization rate, despite being lower when compared with subtotal occlusion, remains an issue. Longer follow-up is required.
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