Korean J Radiol.  2019 Sep;20(9):1390-1398. 10.3348/kjr.2018.0914.

De Novo Intracranial Aneurysms Detected on Imaging Follow-Up of Coiled Aneurysms in a Korean Population

• Yeon EK
• Cho YD
• Yoo DH
• Lee SH
• Kang HS
• Cho WS
• Kim JE
• Han MH

• KMID: 2455767
• DOI: http://doi.org/10.3348/kjr.2018.0914

Abstract

OBJECTIVE
Coiled aneurysms are known to recanalize over time, making follow-up evaluations mandatory. Although de novo intracranial aneurysms (DNIAs) are occasionally detected during routine patient monitoring, such events have not been thoroughly investigated to date. Herein, we generated estimates of DNIA development during long-term observation of coiled cerebral aneurysms, focusing on incidence and the risk factors involved.
MATERIALS AND METHODS
In total, 773 patients undergoing coil embolization of intracranial aneurysms between 2008 and 2010 were reviewed retrospectively. Their medical records and radiologic data accrued over the extended period (mean, 52.7 ± 29.7 months) were analyzed. For the detection of DNIA, follow-up magnetic resonance angiography and/or conventional angiography were used. The incidence of DNIAs and related risk factors were analyzed using Cox proportional hazards regression and Kaplan-Meier product-limit estimator.
RESULTS
In 19 (2.5%) of the 773 patients with coiled aneurysms, DNIAs (0.56% per patient-year) developed during continued long-term monitoring (3395.3 patient-years). Of these, 9 DNIAs (47.4%) were detected within 60 months, with 10 (52.6%) emerging thereafter. The most common site involved was the posterior communicating artery (n = 6), followed by the middle cerebral artery (n = 5) and the basilar top (n = 4). Multivariate analysis indicated that younger age (< 50 years) (hazard ratio [HR] = 1.045; p = 0.010) and recanalization of coiled aneurysms (HR = 2.560; p = 0.047) were significant factors in DNIA formation, whereas female sex, smoking, and hypertension fell short of statistical significance. Cumulative survival rates without DNIA were significantly higher in older subjects (> 60 years; p < 0.001) and in the absence of post-coiling aneurysm recurrence (p = 0.006).
CONCLUSION
In most patients with coiled aneurysms, development of DNIAs during long-term monitoring is rare. However, younger patients (< 50 years) or patients with recurring aneurysms appear to be predisposed to DNIAs.

Keyword

Aneurysm; Follow up; De novo; Coil embolization

MeSH Terms

Aneurysm*
Angiography
Arteries
Embolization, Therapeutic
Female
Follow-Up Studies*
Humans
Hypertension
Incidence
Intracranial Aneurysm*
Magnetic Resonance Angiography
Medical Records
Middle Cerebral Artery
Monitoring, Physiologic
Multivariate Analysis
Recurrence
Retrospective Studies
Risk Factors
Smoke
Smoking
Survival Rate
Smoke

Figure

• 

  Fig. 1 Representative case of de novo aneurysm.(A) Pre- and (B) post-embolization angiographic images of ruptured anterior communicating artery aneurysm. C. Conventional angiography with 6-month follow-up shows major recanalization of coiled aneurysm. D. Post-procedural angiography after additional coiling confirms successful occlusion of aneurysm. (E) Magnetic resonance and (F) conventional angiography in 60-month follow-up show de novo aneurysm (arrows) adjacent to coiled aneurysm (arrowheads).

• 

  Fig. 2 Kaplan-Meier estimates of de novo aneurysm-free cumulative survival for (A) age at initial diagnosis of aneurysm and (B) recanalization of coiled aneurysm.DNIA = de novo intracranial aneurysm

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