Coiling of large and giant aneurysms: complications and long-term results of 334 cases

N Chalouhi; S Tjoumakaris; L F Gonzalez; A S Dumont; R M Starke; D Hasan; C Wu; S Singhal; L A Moukarzel; R Rosenwasser; P Jabbour

doi:10.3174/ajnr.A3696

Back

Coiling of large and giant aneurysms: complications and long-term results of 334 cases

Journal article

Open access

Peer reviewed

Coiling of large and giant aneurysms: complications and long-term results of 334 cases

N Chalouhi, S Tjoumakaris, L F Gonzalez, A S Dumont, R M Starke, D Hasan, C Wu, S Singhal, L A Moukarzel, R Rosenwasser, …

American journal of neuroradiology : AJNR, Vol.35(3), pp.546-552

03/2014

DOI: 10.3174/ajnr.A3696

PMID: 23945229

Files and links (1)

url

https://doi.org/10.3174/ajnr.A3696View

Published (Version of record) Open Access

Abstract

Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥ 10 mm) and identify predictors of outcome. A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling. Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome. Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.

Embolization, Therapeutic - instrumentation

Multivariate Analysis

Humans

Middle Aged

Male

Treatment Outcome

Young Adult

Endovascular Procedures - instrumentation

Regression Analysis

Intracranial Aneurysm - therapy

Time Factors

Adolescent

Aged, 80 and over

Adult

Female

Aged

Retrospective Studies

Intracranial Aneurysm - pathology

Details

Title: Subtitle: Coiling of large and giant aneurysms: complications and long-term results of 334 cases
Creators: N Chalouhi - From the Department of Neurosurgery (N.C., S.T., L.F.G., A.S.D., R.M.S., C.W., S.S., L.A.M., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
S Tjoumakaris
L F Gonzalez
A S Dumont
R M Starke
D Hasan
C Wu
S Singhal
L A Moukarzel
R Rosenwasser
P Jabbour
Resource Type: Journal article
Publication Details: American journal of neuroradiology : AJNR, Vol.35(3), pp.546-552
DOI: 10.3174/ajnr.A3696
PMID: 23945229
NLM abbreviation: AJNR Am J Neuroradiol
ISSN: 0195-6108
eISSN: 1936-959X
Publisher: United States
Language: English
Date published: 03/2014
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
Record Identifier: 9984040224202771

Metrics

12 Record Views

94 Times Cited - Web of Science