Coiling of large and giant aneurysms: complications and long-term results of 334 cases.
Publication/Presentation Date
3-1-2014
Abstract
BACKGROUND AND PURPOSE: Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥ 10 mm) and identify predictors of outcome.
MATERIALS AND METHODS: A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling.
RESULTS: Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome.
CONCLUSIONS: Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.
Volume
35
Issue
3
First Page
546
Last Page
552
ISSN
1936-959X
Published In/Presented At
Chalouhi, N., Tjoumakaris, S., Gonzalez, L. F., Dumont, A. S., Starke, R. M., Hasan, D., Wu, C., Singhal, S., Moukarzel, L. A., Rosenwasser, R., & Jabbour, P. (2014). Coiling of large and giant aneurysms: complications and long-term results of 334 cases. AJNR. American journal of neuroradiology, 35(3), 546–552. https://doi.org/10.3174/ajnr.A3696
Disciplines
Medicine and Health Sciences
PubMedID
23945229
Department(s)
Department of Surgery
Document Type
Article
