Predictors of Cerebral Aneurysm Rupture after Coil Embolization: Single-Center Experience with Recanalized Aneurysms

Fellows’ Journal Club

The authors evaluated a total of 426 unruptured aneurysms and 169 ruptured aneurysms that underwent coil embolization in their institution between January 2009 and December 2017. Recanalization occurred in 38 (8.9%) of 426 unruptured aneurysms and 37 (21.9%) of 169 ruptured aneurysms. The Modified Raymond-Roy Classification on DSA was used to categorize the recanalization type. In untreated recanalized aneurysms, class IIIb aneurysms ruptured significantly more frequently than class II and IIIa. In the ruptured group, the median follow-up term was 28.0 months. Retreatment for recanalization was performed in 16 aneurysms. Four of 21 untreated recanalized aneurysms (2.37% of total coiled aneurysms) ruptured. Class IIIb aneurysms ruptured significantly more frequently than class II and IIIa. Coiled aneurysms with class IIIb recanalization should undergo early retreatment because of an increased rupture risk.

Abstract

DSA findings for ruptured recanalized aneurysms in the ruptured group. Case 1-pre: preprocedural anterior communicating artery aneurysm; case 1-post: class II aneurysm occlusion immediately after the procedure; case 1–1w: class IIIb recanalization at 1 week after the procedure; case 1–1m: ruptured recanalized aneurysm with a new bleb at 1 month after the procedure; case 2-pre: preprocedural anterior communicating artery aneurysm; case 2-post: class II aneurysm occlusion immediately after the procedure; case 2–1w: class IIIb recanalization at 1 week after the procedure; case 2–1m: ruptured recanalized aneurysm with a new bleb at 1 month after the procedure; case 3-pre: preprocedural ICA–posterior communicating artery aneurysm; case 3-post: class IIIb aneurysm occlusion immediately after the procedure; case 3–6m: progression of the class IIIb recanalization at 6 months after the procedure; case 3–29m: ruptured recanalized aneurysm at 29 months after the procedure; case 4-pre: preprocedural ICA–posterior communicating artery aneurysm; case 4-post: class IIIb aneurysm occlusion immediately after the procedure; case 4–6m: progression of the class IIIb recanalization at 6 months after the procedure; case 4–7m: ruptured recanalized aneurysm at 7 months after the procedure.

BACKGROUND AND PURPOSE

Recanalization after coil embolization is widely studied. However, there are limited data on how recanalized aneurysms rupture. Herein, we describe our experience with the rupture of recanalized aneurysms and discuss the type of recanalized aneurysms at greatest rupture risk.

MATERIALS AND METHODS

A total of 426 unruptured aneurysms and 169 ruptured aneurysms underwent coil embolization in our institution between January 2009 and December 2017. Recanalization occurred in 38 (8.9%) of 426 unruptured aneurysms (unruptured group) and 37 (21.9%) of 169 ruptured aneurysms (ruptured group). The Modified Raymond-Roy classification on DSA was used to categorize the recanalization type. Follow-up DSA was scheduled until 6 months after treatment, and follow-up MRA was scheduled yearly. If recanalization was suspected on MRA, DSA was performed.

RESULTS

In the unruptured group, the median follow-up term was 74.0 months. Retreatment for recanalization was performed in 18 aneurysms. Four of 20 untreated recanalized aneurysms (0.94% of total coiled aneurysms) ruptured. In untreated recanalized aneurysms, class IIIb aneurysms ruptured significantly more frequently than class II and IIIa (P = .025). In the ruptured group, the median follow-up term was 28.0 months. Retreatment for recanalization was performed in 16 aneurysms. Four of 21 untreated recanalized aneurysms (2.37% of total coiled aneurysms) ruptured. Class IIIb aneurysms ruptured significantly more frequently than class II and IIIa (P = .02).

CONCLUSIONS

The types of recanalization after coil embolization may be predictors of rupture. Coiled aneurysms with class IIIb recanalization should undergo early retreatment because of an increased rupture risk.

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