J Korean Neurosurg Soc.  2015 Apr;57(4):250-257. 10.3340/jkns.2015.57.4.250.

Angiographic Results of Wide-Necked Intracranial Aneurysms Treated with Coil Embolization : A Single Center Experience

• Song JH
• Chang IB
• Ahn JH
• Kim JH
• Oh JK
• Cho BM

• KMID: 1956422
• DOI: http://doi.org/10.3340/jkns.2015.57.4.250

Abstract

OBJECTIVE
Endovascular treatment of wide-necked intracranial aneurysms is a challenge and the durability and the safety of these treated aneurysms remain unknown. The aim of this study was to evaluate the clinical and long-term angiographic results of wide-necked intracranial aneurysms treated with coil embolization.
METHODS
Between January 2002 and December 2012, 53 wide-necked aneurysms treated with coil embolization were selected. Forty were female, and 13 were male. Twenty eight (52.8%) were ruptured aneurysms, and 25 (47.2%) were unruptured aneurysms. The patents' medical and radiological records were reviewed retrospectively.
RESULTS
Of the 53 aneurysms, coiling alone was employed in 45 (84.9%) and stent-assisted coiling was done in 8 (15.1%). The initial angiographic results revealed Raymond class 1 (complete occlusion) in 30 (56.6%) cases, Raymond class 2 (residual neck) in 18 (34.0%) cases, and Raymond class 3 (residual sac) in 5 (9.4%) cases. The mean angiographic follow-up period was 37.9 months (12-120 months). At the last angiographies, Raymond class 1 was seen in 26 (49.1%) cases, Raymond class 2 in 16 (30.2%), and Raymond class 3 in 11 (20.8%). Angiographic recurrence occurred in 22 (41.5%) patients, with minor recurrence in 7 (13.2%) cases and major recurrence in 15 (28.3%). Retreatment was performed in 8 cases (15.1%). A suboptimal result on the initial angiography was a significant predictor of recurrence in this study (p=0.03).
CONCLUSION
The predictor of recurrence in wide-necked aneurysms is a suboptimal result on the initial angiography. Long-term angiographic follow-up is recommended in wide-necked aneurysms.

Keyword

Cerebral angiography; Intracranial aneurysm; Recurrence

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Angiography
Cerebral Angiography
Embolization, Therapeutic*
Female
Follow-Up Studies
Humans
Intracranial Aneurysm*
Male
Recurrence
Retreatment
Retrospective Studies

Figure

• 

  Fig. 1 Cerebral angiograms of a 44-year-old woman showing minor change. A : A left ICA angiogram shows a paraclinoid wide-necked aneurysm. B : An immediate angiogram after coil embolization shows near complete packing. C : An angiogram obtained 10 months later shows contrast filling in the aneurysm neck (minor change). D : A follow-up angiogram at 58 months shows neck filling, but no more severe compaction. ICA : internal carotid artery.

• 

  Fig. 2 Cerebral angiograms of a 69-year-old woman showing major change. A : A left ICA angiogram shows a ruptured large aneurysm arising from the posterior communicating artery. B : An angiogram obtained immediately after coil embolization shows near complete packing. C : A follow-up angiogram obtained 12 months later shows coil compaction and contrast filling in the aneurysm sac (major change). D : An angiogram immediately after second coil embolization shows mild neck filling. ICA : internal carotid artery.

• 

  Fig. 3 Cerebral angiograms of a 62-year-old woman showing better change (progressive thrombosis). A and B : A left ICA angiogram reveals a superior hypophysial artery aneurysm identified incidentally. C : An angiogram immediately after coil embolization with double microcatheters reveals neck filling. D : A follow-up angiogram performed 6 months later reveals progressive thrombosis. ICA : internal carotid artery.

• 

  Fig. 4 Cerebral angiograms of a 39-year-old man treated with coil embolization and surgical clipping. A : A left ICA angiogram shows a ruptured anterior communicating artery aneurysm. B : An immediate angiogram after coil embolization shows complete occlusion. C and D : Contrast filling in the aneurysm neck is seen at the angiogram performed 24 months later and no severe change at 50 month follow-up. E and F : A follow-up angiogram 120 months later reveals more compaction with a bleb. G : After surgical clipping, the angiogram shows totally obliterated aneurysm. ICA : internal carotid artery.

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