Follow-up outcomes after re-embolization for recanalized aneurysms after initial coiling: further recurrence rates and related risk factors.

Follow-up outcomes after re-embolization for recanalized aneurysms after initial coiling: further recurrence rates and related risk factors.

World Neurosurg. 2018 Mar 09;:

Authors: Lee J, Lim JW, Cho YD

Abstract
BACKGROUND: Although it is well known that coiled aneurysms can recanalize over time, long-term outcomes of re-embolization for recurred aneurysms have not been adequately investigated. We studied the retreatment outcomes of re-embolized aneurysms during follow-up monitoring and assessed the risk factors related to further recanalization.
METHODS: A total of 129 patients with 133 aneurysms were retrospectively reviewed. Each aneurysm was subjected to re-embolization because of major recanalization after initial coil embolization, and underwent midterm and extended monitoring after retreatment. Cumulative medical records and radiologic data were assessed. Repeat recurrence rates and related risk factors were assessed by binary logistic regression analysis.
RESULTS: A total of 47 aneurysms (35.3%) displayed re-recanalization at 6 months post-reembolization, with 17 and 30 instances of minor and major recanalization, respectively. Multivariate analysis indicated that posterior circulation (HR=6.129; p=0.010), large aneurysm (>7 mm) (HR=13.598; p<0.001), and incomplete occlusion at the second coiling (HR=9.975; p=0.001) were significant factors for repeat recanalization. Of 86 aneurysms showing complete occlusion at the mid-term, 76 were further evaluated (≥12 months), displaying 18 aneurysms (23.7%) of delayed re-recanalization during a follow-up of 230.1 aneurysm-years. Of 15 aneurysms with minor recanalization at the 6-month, 6 (40.0%) progressed to major recanalization during a follow-up of 44.0 aneurysm-years.
CONCLUSIONS: The majority of recoiled aneurysms (64.7%) displayed complete occlusion at the 6-month follow-up. However, posterior circulation, large aneurysm (>7 mm), and incomplete occlusion at the second coiling were risks for further recanalization. The mid-term and delayed re-recanalization rates of the re-embolized aneurysms seem to be higher than those of the initial aneurysms.

PMID: 29530696 [PubMed - as supplied by publisher]

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