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Microsurgical Creation of Giant Bifurcation Aneurysms in Rabbits for the Evaluation of Endovascular Devices
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Coiling of large and giant aneurysms: complications and long-term results of 334 cases

N Chalouhi1, S Tjoumakaris, L F Gonzalez

  • 1From the Department of Neurosurgery (N.C., S.T., L.F.G., A.S.D., R.M.S., C.W., S.S., L.A.M., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.

AJNR. American Journal of Neuroradiology
|August 16, 2013
PubMed

Insights

Coiling large brain aneurysms is safe with good outcomes, but reopening is common. Stent-assisted coiling reduces recurrence and rebleeding compared to conventional coiling.

Area of Science:

  • Neurosurgery
  • Interventional Neuroradiology
  • Vascular Neurology

Background:

  • Large and giant intracranial aneurysms (≥ 10 mm) are increasingly managed with endovascular techniques.
  • Coil embolization is a primary endovascular treatment modality for these complex lesions.

Purpose of the Study:

  • To retrospectively analyze complications and long-term outcomes of coiling large and giant intracranial aneurysms (≥ 10 mm).
  • To identify predictors of procedural complications, recurrence, retreatment, and clinical outcomes.

Main Methods:

  • Retrospective review of 334 large/giant aneurysms treated with coiling between 2004-2011.
  • Analysis of baseline characteristics, procedural details (conventional, stent-assisted, balloon-assisted coiling, parent vessel occlusion), complications, and clinical/angiographic outcomes.
  • Average aneurysm size was 15 mm; follow-up averaged 25.4 months for 84% of patients.

Main Results:

  • Complications occurred in 10.5% of patients (0.3% mortality); aneurysm location and rupture status predicted complications.
  • Recanalization and retreatment rates were 39% and 33%, respectively. Larger size, longer follow-up, conventional coiling, and location predicted recurrence.
  • Annual rebleeding rate was 1.9%. Larger size, longer follow-up, and location predicted hemorrhage. Favorable outcomes in 92%; larger size and poor Hunt and Hess grade predicted poor outcome.

Conclusions:

  • Coiling large/giant aneurysms offers a reasonable safety profile and good clinical outcomes, though reopening is frequent.
  • Stent-assisted coiling demonstrated lower recurrence, retreatment, and rebleeding rates than conventional coiling without increased morbidity.
  • Aneurysm size is a significant predictor of recanalization, retreatment, rebleeding, and poor clinical outcome.
Abstract

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