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Late Adverse Events in Coiled Ruptured Aneurysms with Incomplete Occlusion at 6-Month Angiographic Follow-Up

Late Adverse Events in Coiled Ruptured Aneurysms with Incomplete Occlusion at 6-Month... This Article Figures Only Full Text Full Text (PDF) Supplemental Online Table All Versions of this Article: ajnr.A1841v1 31/3/464 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Ferns, S.P. Articles by van Rooij, W.J. PubMed PubMed Citation Articles by Ferns, S.P. Articles by van Rooij, W.J. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:464-469, March 2010 © 2010 American Society of Neuroradiology INTERVENTIONAL Late Adverse Events in Coiled Ruptured Aneurysms with Incomplete Occlusion at 6-Month Angiographic Follow-Up S.P. Ferns a , C.B.L.M. Majoie a , M. Sluzewski b and W.J. van Rooij b a From the Department of Radiology (S.P.F., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands b 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@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: AcomA, anterior communicating artery • AICA, anterior inferior cerebellar artery • Ant, anterior • CARAT, Cerebral Aneurysm Rerupture After Treatment • CI, confidence interval • ISAT, International Subarachnoid Aneurysm Trial • m, months • MCA, middle cerebral artery • PCA, posterior cerebral artery • PcomA, posterior communicating artery • PICA, posterior inferior cerebellar artery • PVO, parent vessel occlusion • SAH, subarachnoid hemorrhage • SCA, superior cerebellar artery Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Late Adverse Events in Coiled Ruptured Aneurysms with Incomplete Occlusion at 6-Month Angiographic Follow-Up

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1841
Publisher site
See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) Supplemental Online Table All Versions of this Article: ajnr.A1841v1 31/3/464 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Ferns, S.P. Articles by van Rooij, W.J. PubMed PubMed Citation Articles by Ferns, S.P. Articles by van Rooij, W.J. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:464-469, March 2010 © 2010 American Society of Neuroradiology INTERVENTIONAL Late Adverse Events in Coiled Ruptured Aneurysms with Incomplete Occlusion at 6-Month Angiographic Follow-Up S.P. Ferns a , C.B.L.M. Majoie a , M. Sluzewski b and W.J. van Rooij b a From the Department of Radiology (S.P.F., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands b 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@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: AcomA, anterior communicating artery • AICA, anterior inferior cerebellar artery • Ant, anterior • CARAT, Cerebral Aneurysm Rerupture After Treatment • CI, confidence interval • ISAT, International Subarachnoid Aneurysm Trial • m, months • MCA, middle cerebral artery • PCA, posterior cerebral artery • PcomA, posterior communicating artery • PICA, posterior inferior cerebellar artery • PVO, parent vessel occlusion • SAH, subarachnoid hemorrhage • SCA, superior cerebellar artery Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: Mar 1, 2010

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