Background: Large intracranial aneurysm is challenging for both surgical and endovascular treatment. High recurrence and retreatment rates are still limitations for endovascular treatment. Analysing risk factors of recurrence after endovascular treatment can be useful for planning future treatment strategies.
Method: We retrospectively reviewed patients with intracranial saccular aneurysm (≥ 8 mm) who underwent endovascular treatment from 2008 to 2017 at our institution. The demographic features, clinical information and angiographic results were analysed to reveal the risk factors for recurrence and retreatment. Subgroup analysis was performed according to packing density (PD) and stent insertion status.
Results: The total recurrence and retreatment rates were 25.7% (44/171) and 10.5% (18/171), respectively. Independent risk factors for recurrence after endovascular treatment were larger aneurysm size (OR 1.32; 95% CI 1.17-1.51; p < 0.001), ruptured status (OR 3.91; 95%CI 1.44-10.90; p = 0.008), initial incomplete occlusion (OR 2.72; 95%CI 1.18-6.41; p = 0.020), and low dome-to-neck ratio (OR 0.61; 95%CI 0.36-0.97; p = 0.047). The recurrence rate for the no-stent with low PD (< 17.5%) group was 50% (14/28); 37.5% (6/16) for stent-assisted coil (SAC) with low PD group, 22.0% (20/91) for no-stent with high PD group and 11.1% (4/36) for SAC with high PD group.
Conclusion: The independent risk factors for recurrence after endovascular treatment in large (≥ 8 mm) intracranial saccular aneurysm were larger aneurysm size, ruptured status, low dome-to-neck ratio and initial incomplete occlusion state. SAC is a useful method for lowering recurrence after endovascular treatment for relatively large (≥ 8 mm) cerebral aneurysm.
Keywords: Endovascular procedure; Intracranial aneurysm; Recurrence; Stents.