J Korean Neurosurg Soc.  2022 Sep;65(5):710-718. 10.3340/jkns.2022.0088.

Angiographic Follow-Up for Small Ruptured Intracranial Aneurysm Treated by Endovascular Treatment : Follow-Up Plan and Long-Term Follow-Up Results

• Kim TH
• Ko JH
• Chung J

• KMID: 2533033
• DOI: http://doi.org/10.3340/jkns.2022.0088

Abstract

Objective
: Although endovascular treatment for intracranial aneurysms is considered effective and safe, its durability is still debated. Also, few studies have described angiographic follow-up plan after endovascular treatment of intracranial aneurysm, especially in ruptured cases. Hence, we report the long-term results of follow-up angiography protocol.
Methods
: Radiological records of 639 cases of coil embolization with ruptured aneurysms from March 2003 to December 2016 were retrospectively reviewed. Patients who received treatment of a saccular aneurysm less than 7 mm resulted with near complete occlusion were included. Two hundred thirty-eight aneuryms which received the follow-up angiography at least once were enrolled. We classified four periods of follow-up as follows : post-treatment 1 year (defined as the first period), from 1 to 2 years (the second period), 2 to 5 years (the third period), and over 5 years (long-term).
Results
: We identified 14 cases (6.4%) of recurrence from 218 aneurysms in follow-up angiography in the first period. Among 143 aneurysms in the second period, five cases (3.5%) of recurrence were identified. There were no findings suspicious of recanalization in 97 patients in the third period. Of the total 238 cases, there were 19 recurrences, for a recurrence rate of 8.0%. Six (31.6%) out of 19 recurrences showed a tendency toward repeat recurrences even after additional treatment. Twenty-eight received long-term follow-up over 5 years and there was no recurrence.
Conclusion
: Most of the recurrence were found during the first and the second year. We suggest that at least one digital subtraction angiography examination may be necessary around post-treatment 2 years, especially in ruptured cases. If the angiographic results are favorable at 2 years post-treatment, long-term result should be favorable.

Keyword

Intracranial aneurysm; Ruptured aneurysm; Endovascular treatment; Angiography, follow up

Figure

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  Fig. 1. Flowchart demonstrating the selection process used for the present study.

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  Fig. 2. The follow-up angiography protocol set by this institution.

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  Fig. 3. A 45-year-old male treated with stent assisted coil embolization for right middle cerebral artery ruptured aneurysm (case 12 in Table 2). A : Transfemoral angiographic finding of the right middle cerebral artery aneurysm. B : Immediate post-embolization angiography shows nearly completely occluded aneurysm with small amount of contrast filling of the residual neck (Raymond-Roy Occlusion classification class II, white arrowhead). C : On post-embolization 10-month angiography, the aneurysm was filled with contrast, which showed recurrence which required retreatment.

Reference

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