Coiling of Large and Giant Aneurysms: Complications and Long-Term Results of 334 Cases

Fellows’ Journal Club

March 2014

(3 of 3)

The long-term complications of coil treatment of giant intracranial aneurysms were assessed in 334 instances when treatment consisted of only coiling (225), stent-assisted coiling (88), parent vessel occlusion (14), or balloon-assisted coiling (7). The authors concluded that coiling of large and giant aneurysms has reasonable safety profiles with good clinical outcomes, but aneurysm reopening was common. Stent-assisted coiling had lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.

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Abstract

BACKGROUND AND PURPOSE
Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥10 mm) and identify predictors of outcome.

MATERIALS AND METHODS
A total of 334 large or giant aneurysms (≥10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling.

RESULTS
Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome.

CONCLUSIONS
Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.

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Coiling of Large and Giant Aneurysms: Complications and Long-Term Results of 334 Cases
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Mauricio Castillo
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