Extended monitoring of re-coiled cerebral aneurysms after initial postcoiling recanalization: Safety and durability of repeat coil embolization

Jin Woo Bae; Han San Oh; Chang-Eui Hong; Kang Min Kim; Dong Hyun Yoo; Hyun-Seung Kang; Young Dae Cho

doi:10.1016/j.neurad.2023.05.006

Extended monitoring of re-coiled cerebral aneurysms after initial postcoiling recanalization: Safety and durability of repeat coil embolization

J Neuroradiol. 2024 Feb;51(1):59-65. doi: 10.1016/j.neurad.2023.05.006. Epub 2023 May 27.

Authors

Jin Woo Bae¹, Han San Oh², Chang-Eui Hong³, Kang Min Kim², Dong Hyun Yoo⁴, Hyun-Seung Kang², Young Dae Cho⁵

Affiliations

¹ Department of Neurosurgery, Inha University Hospital, Incheon, Korea.
² Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
³ Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea.
⁴ Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
⁵ Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. Electronic address: aronnn@naver.com.

PMID: 37247754
DOI: 10.1016/j.neurad.2023.05.006

Abstract

Purpose: In the endovascular era, postcoiling recanalization of cerebral aneurysms is occurring with greater frequency. Repeat coiling is usually done to prevent rebleeding, although long-term outcomes of re-embolization have yet to be adequately investigated. The present study was undertaken to assess clinical and radiographic outcomes of re-embolization in recanalized aneurysms, focusing on procedural safety, efficacy, and durability.

Method: In this retrospective review, we examined 308 patients with 310 recurrent aneurysms. All lesions were re-coiled, once major recanalization (after initial coil embolization) was established. Medical records and radiologic data amassed during extended follow-up were then subject to review. Cox proportional hazards regression analysis was undertaken to identify risk factors for subsequent recurrence.

Result: During a lengthy follow-up (mean, 40.2 ± 33.0 months), major recanalization developed again in 87 aneurysms (28.1%). Multivariable Cox regression analysis linked re-recanalization to initial saccular neck width (p=.003) and autosomal dominant polycystic kidney disease (ADPKD; p<.001). Stent implantation (p=.038) and successful occlusion at second coiling (p=.012) were protective against later recanalization in this setting. The more recent the second embolization was performed, the lower the risk of further recurrence (p=.023). Procedure-related complications included asymptomatic thromboembolism (n = 9), transient ischemic neurologic deficits (n = 2), procedural bleeding (n = 1), and coil migration (n = 1), but there were no residual effects or deaths.

Conclusion: Repeat coil embolization is a safe therapeutic option for recanalized cerebral aneurysms. Wide-necked status and ADPKD emerged as risks for subsequent recanalization, whereas successful occlusion and stent implantation seemed to reduce the likelihood of recurrence after re-embolization procedures.

Keywords: Aneurysm; Coil; Durability; Embolization; Recanalization; Retreatment.

MeSH terms

Cerebral Angiography
Embolization, Therapeutic* / methods
Follow-Up Studies
Humans
Intracranial Aneurysm* / diagnostic imaging
Intracranial Aneurysm* / etiology
Intracranial Aneurysm* / therapy
Polycystic Kidney, Autosomal Dominant* / etiology
Polycystic Kidney, Autosomal Dominant* / therapy
Retrospective Studies
Stents
Treatment Outcome