Recurrence pattern predicts aneurysm rupture after coil embolization

Iku Nambu, Kouichi Misaki, Takehiro Uno, Akifumi Yoshikawa, Naoyuki Uchiyama, Masanao Mohri and Mitsutoshi Nakada

PLOS ONE, 2022, vol. 17, issue 9, 1-12

Abstract: Introduction: Hemorrhage from a recurrent aneurysm is a major concern after coiling for intracranial aneurysms. We aimed to identify aneurysm recurrence patterns associated with hemorrhage. Material and methods: We investigated radiological data of patients who underwent coiling for intracranial aneurysms in 2008–2016 and were followed-up for at least 6 months. Aneurysm recurrence patterns were classified as: type Ⅰ, enlargement of aneurysm neck; type Ⅱ, recurrent cavity within the coil mass; type Ⅲ, recurrent cavity along the aneurysm wall; and type Ⅳ, formation of a daughter sac. We evaluated the incidence of various recurrence patterns with or without hemorrhage. Results: Of the 173 aneurysms included in the study (mean follow-up period, 32 months; range, 6–99 months), 22 (13%) recurred and required re-treatment. The recurrence patterns included type Ⅰ, Ⅱ, Ⅲ, and Ⅳ in 7 (4%), 4 (2%), 9 (5%), and 2 (1%) cases, respectively. Most of the type Ⅰ, Ⅱ, and Ⅲ recurrences occurred within 1 year, and type Ⅳ occurred at 7 years after coiling. Three aneurysms exhibited hemorrhage, one with type Ⅲ and two with type Ⅳ pattern. The two aneurysms with type Ⅳ recurrence initially occurred as type Ⅰ; however, the recurrent neck enlarged gradually, resulting in new sac formation. Conclusions: We recommend prompt re-treatment for aneurysms recurring with type Ⅲ or Ⅳ patterns, as such patterns were associated with hemorrhage. Furthermore, we need a special care to type Ⅰ recurrence with enlargement of recurrent neck because this specific pattern may develop to type Ⅳ.

Date: 2022
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0261996

DOI: 10.1371/journal.pone.0261996

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