American Journal of Neuroradiology
DOI 10.3174/ajnr.A1841
INTERVENTIONAL
Late Adverse Events in Coiled Ruptured Aneurysms with Incomplete Occlusion at 6-Month Angiographic Follow-Up
From the Department of Radiology (S.P.F., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; and Department of Radiology (M.S., W.J.v.R.), St. Elisabeth Hospital, Tilburg, the Netherlands.
Please address correspondence to Sandra P. Ferns, MD, Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; e-mail: S.P.Ferns{at}amc.uva.nl
BACKGROUND AND PURPOSE: Patients with coiled ruptured aneurysms with incomplete occlusion at 6 months are not only at risk for rebleed during further follow-up but also for complications of angiographic follow-up and retreatment, and for progressive mass effect by uncontrollable aneurysm growth. We assessed the frequency and outcome of all these possible aneurysm-related events in 124 patients with incompletely occluded aneurysms at 6 months during a follow-up of 419 patient-years.
MATERIALS AND METHODS: Between 1994 and 2007, 901 ruptured aneurysms were coiled and 713 (79%) had 6-month angiographic follow-up, of which 124 were incompletely occluded (17%). These 124 patients were followed for a mean of 41 months (median, 30 months; range, 1–150 months).
RESULTS: During follow-up, 307 angiograms were obtained without complications. Of 124 aneurysms, 88 were retreated (71%). Fifteen aneurysms were retreated more than once. Altogether, 124 additional treatments were performed, and no complications occurred (0%; 95% CI, 0.0–3.6%). Four aneurysms rebled, causing death in 2 patients. Another 4 patients experienced progressive mass effect by growth of the coiled aneurysm, leading to death in 1. The annual event rate was 1.9%, the annual mortality was 0.7%, and the annual rebleed rate was 1.0% (8, 3, and 4 in 419 patient-years).
CONCLUSIONS: In this study of patients with coiled ruptured aneurysms with incomplete occlusion at 6 months, a strategy of imaging follow-up and retreatment when possible leads to a low incidence of serious adverse events. Rebleeding and progressive mass effect of the aneurysm were responsible for these events, not complications from additional treatment or angiographic follow-up.
Abbreviations: SCA, superior cerebellar artery