Long-term Angiographic Follow-up of 169 Intracranial Berry Aneurysms Occluded with Detachable Coils
Abstract
PURPOSE: To evaluate the stability of aneurysm occlusion at follow-up angiography after endovascular treatment (EVT) with detachable coils in intracranial berry aneurysms.
MATERIALS AND METHODS: A total of 203 berry aneurysms (<1.5 cm) were treated with EVT. Follow-up angiography at least 3 months later was performed in 169 cases.
RESULTS: Complete occlusion of the aneurysm sac and neck was achieved in 148 aneurysms, subtotal occlusion in 18, and incomplete occlusion in three. Recurrence occurred between 3 and 40 months in 20 (14%) of the 148 totally occluded aneurysms. A second treatment was performed in five cases, was scheduled in one, and failed in one. The small neck remnant increased in size but did not require any retreatment in three cases, and the size of the neck remnant remained stable in 10 cases. Remnant regrowth occurred in six of the 18 subtotally occluded aneurysms. A second treatment was performed in three. Of the 169 cases, last follow-up angiography showed total occlusion in 133 cases, subtotal in 30, and incomplete in six. No rebleeding occurred.
CONCLUSION: A very small recurrence may be observed at the level of the neck of the aneurysm at long-term follow-up angiography despite achieving total occlusion initially with detachable coils.
References
- 1 Halbach VV, Higashida RT, Dowd CF, et al. The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg 1994; 80:659-666. Crossref, Medline, Google Scholar
- 2 Guglielmi G, Vinuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. II. Preliminary clinical experience. J Neurosurg 1991; 75:8-14. Google Scholar
- 3 Guglielmi G, Vinuela F, Duckwiler G, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 1992; 77:515-524. Crossref, Medline, Google Scholar
- 4 Massoud T, Guglielmi G, Vinuela F, Duckwiler G. Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. AJNR 1996; 17:549-554. Medline, Google Scholar
- 5 Zubilaga A, Gugliemi G, Vinuela F, Duckwiler G. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 1994; 15:815-820. Medline, Google Scholar
- 6 Raymond J, Roy D, Bojanowski M, Moumdjian R, L'Esperance G. Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 1997; 86:211-219. Crossref, Medline, Google Scholar
- 7 Pierot L, Boulin A, Castaing L, Rey A, Moret J. Selective occlusion of the basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery 1996; 38:948-954. Crossref, Medline, Google Scholar
- 8 Cognard C, Pierot L, Boulin A, et al. Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms. Radiology 1997; 202:783-792. Link, Google Scholar
- 9 Cognard C, Weill A, Castaings L, Rey A, Moret J. Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 1998; 206:499-510. Link, Google Scholar
- 10 Pierot L, Boulin A, Castaing L, Rey A, Moret J. Endovascular treatment of pericallosal artery aneurysms. Neurol Res 1996; 18:49-53. Crossref, Medline, Google Scholar
- 11 Moret L, Pierot L, Boulin A, Castaings L, Rey A. Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils. Neuroradiology 1996; 38:800-805. Crossref, Medline, Google Scholar
- 12 Roy D, Raymond J, Bouthillier A, Bojanowski MW, Moumdjian R, L'Esperance G. Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. AJNR 1997; 18:1207-1215. Medline, Google Scholar
- 13 Vinuela F, Duckwiler G, Mawad M. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 1997; 86:475-482. Crossref, Medline, Google Scholar
- 14 Richling B, Bazinzski G, Gross C, Gruber A, Killer G. Early clinical outcome of patients with ruptured cerebral aneurysms treated by endovascular (GDC) or microsurgical techniques: a single center experience. Intervent Neuroradiol 1995; 1:19-27. Crossref, Medline, Google Scholar
- 15 Graves VB, Strother CM, Duff TA, Perl J. Early treatment of ruptured aneurysms with Guglielmi detachable coils: effects on subsequent bleeding. Neurosurgery 1995; 37:640-648. Crossref, Medline, Google Scholar
- 16 Ahuja A, Graves VB, Barnwell SL, et al. Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils. AJNR ; (in press). Google Scholar
- 17 McDougall C, Halbach V, Dowd C, Higashida R, Larsen D, Hieshima G. Endovascular treatment of basilar tip aneurysms using elactrolytically detachable coils. J Neurosurg 1996; 84:393-399. Crossref, Medline, Google Scholar
- 18 Hodes JE, Fox AJ, Pelz DM, Peerless SJ. Rupture of aneurysms following balloon embolization. J Neurosurg 1990; 72:567-571. Crossref, Medline, Google Scholar
- 19 Casasco AE, Aymard A, Gobin YP, et al. Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 1993; 79:3-10. Crossref, Medline, Google Scholar
- 20 Gurian JH, Martin NA, King W, Duckwiler G, Guglielmi G, Vinuela F. Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete embolization. J Neurosurg 1995; 83:843-853. Crossref, Medline, Google Scholar
- 21 Adamson T, Batjer H. Aneurysm recurrence associated with induced hypertension and hypervolemia. Surg Neurol 1988; 29:57-61. Crossref, Medline, Google Scholar
- 22 Ebina K, Suzuki M, Andoh A. Recurrence of cerebral aneurysm after initial neck clipping. Neurosurgery 1982; 11:764-768. Crossref, Medline, Google Scholar
- 23 Sasaki T, Takeshima T, Tominaga M, Hashimoto H, Kawagichi S. Recurrence of ICA-PCoA aneurysms after neck clipping. J Neurosurg 1994; 80:58-63. Crossref, Medline, Google Scholar
- 24 Weir B, Drake CG. Rapid growth of residual aneurysmal neck during pregnancy. J Neurosurg 1991; 75:780-782. Crossref, Medline, Google Scholar
- 25 Mawad ME, Mawad JK, Cartwright J, Gokaslan Z. Long-term histologic changes in canine aneurysms embolized with Guglielmi detachable coils. AJNR 1995; 16:7-13. Medline, Google Scholar
- 26 Reul J, Weis J, Spetzger U, Konert T, Fricke C, Thron A. Long term angiographic and histopathologic findings in experimental aneurysms of the carotid bifurcation embolized with platinium and tungsten coils. AJNR 1997; 18:35-42. Medline, Google Scholar
- 27 Byrne JV, Hubbard N, Morris JH. The nature of thrombosis induced by platinium and tungsten coils in saccular aneurysms. AJNR 1997; 18:29-33. Medline, Google Scholar
- 28 Molyneux AJ, Ellison DW, Morris J, Byrne JV. Histological findings in giant aneurysms treated with Guglielmi detachable coils. J Neurosurg 1995; 83:129-132. Crossref, Medline, Google Scholar
- 29 Stehbens WE. Etiology of intracranial berry aneurysms. J Neurosurg 1989; 70:823-831. Crossref, Medline, Google Scholar
- 30 Giannotta SL, Litofsky S. Reoperative management of intracranial aneurysms. J Neurosurg 1995; 83:387-393. Crossref, Medline, Google Scholar
- 31 Gobin Y, Vinuela F, Gurian J, et al. Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 1996; 84:55-62. Crossref, Medline, Google Scholar
- 32 Moret J, Cognard C, Weill A, Castaings L, Rey A. The “remodelling technique” in the treatment of wide neck intracranial aneurysms. Intervent Neuroradiol 1997; 3:21-35. Crossref, Medline, Google Scholar
- 33 Forsting M, Albert FK, Jansen O, et al. Coil placement after clipping: endovascular treatment of incompletely clipped cerebral aneurysms. J Neurosurg 1996; 85:966-969. Crossref, Medline, Google Scholar
- 34 Civit T, Auque J, Marchal JC. Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery 1996; 38:955-961. Crossref, Medline, Google Scholar
- 35 Chavis TD, Hopkins LN. Comments on Graves VB, Strother CM, Duff TA, et al. Early treatment of ruptured aneurysms with Guglielmi Detachable coils: effects on subsequent bleeding. Neurosurgery 1995; 37:647-648. Google Scholar
- 36 Drake CG, Vanderlinden RG. The late consequences of incomplete surgical treatment of cerebral aneurysms. J Neurosurg 1967; 27:226-238. Crossref, Medline, Google Scholar
- 37 Drake CG, Allcock JM. Postoperative angiography and the “slipped” clip. J Neurosurg 1973; 39:683-689. Crossref, Medline, Google Scholar
- 38 Katakura K, Kwak R, Hatanaka M, Suzuki J. Angiographical consideration of residual aneurysms following direct operations on intracranial aneurysms. Neurol Surg (Tokyo) 1979; 7:139-148. Google Scholar
- 39 Alexander TD, MacDonald RL, Weir B, Kowalczuk BA. Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies. Neurosurgery 1996; 39:10-18. Crossref, Medline, Google Scholar
- 40 Martin NA, Bentson J, Vinuela F, et al. Intraoperative digital substraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 1990; 73:526-533. Crossref, Medline, Google Scholar
- 41 Feuerberg I, Linquist C, Linquist M. Natural history of postoperative aneurysmal rests. J Neurosurg 1987; 66:30-34. Crossref, Medline, Google Scholar
- 42 MacDonald RL, Wallace MC, Kestle JR. Role of angiography following aneurysm surgery. J Neurosurg 1993; 79:826-832. Crossref, Medline, Google Scholar
- 43 Barrow DL, Boyer KL, Joseph GJ. Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 1992; 30:153-159. Crossref, Medline, Google Scholar
- 44 MacKissoc W. Recurrence of an intracranial aneurysm after excision. J Neurosurg 1964; 23:547-548. Google Scholar
- 45 Drake CG, Friedman AH, Peerless SJ. Failed aneurysms surgery: reoperation in 115 cases. J Neurosurg 1984; 61:848-856. Crossref, Medline, Google Scholar
- 46 Lin T, Fox AJ, Drake CG. Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 1989; 70:556-560. Crossref, Medline, Google Scholar
- 47 Derdeyn CP, Graves VB, Turski PA, Masaryk AM, Strother CM. MR Angiography of saccular aneurysms after treatment with GDC coils: preliminary experience. AJNR 1997; 18:279-286. Medline, Google Scholar