TY - JOUR
T1 - Long-term catheter angiography after aneurysm coil therapy
T2 - Results of 209 patients and predictors of delayed recurrence and retreatment
AU - Chalouhi, Nohra
AU - Bovenzi, Cory D.
AU - Thakkar, Vismay
AU - Dressler, Jeremy
AU - Jabbour, Pascal
AU - Starke, Robert M.
AU - Teufack, Sonia
AU - Gonzalez, L. Fernando
AU - Dalyai, Richard
AU - Dumont, Aaron S.
AU - Rosenwasser, Robert
AU - Tjoumakaris, Stavropoula
N1 - Publisher Copyright:
© AANS, 2014.
PY - 2014/11
Y1 - 2014/11
N2 - Object. Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment. Methods. Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images. Results. Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment. Conclusions. The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.
AB - Object. Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment. Methods. Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images. Results. Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment. Conclusions. The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.
KW - Angiography
KW - Coil therapy
KW - Interventional neurosurgery
KW - Intracranial aneurysm
KW - Recurrence
KW - Vascular disorders
UR - http://www.scopus.com/inward/record.url?scp=84922393027&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84922393027&partnerID=8YFLogxK
U2 - 10.3171/2014.7.JNS132433
DO - 10.3171/2014.7.JNS132433
M3 - Article
C2 - 25192480
AN - SCOPUS:84922393027
SN - 0022-3085
VL - 121
SP - 1102
EP - 1106
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 5
ER -