Endovascular Treatment of Ruptured Intracranial Aneurysms with Detachable Coils: Long-term Clinical and Serial Angiographic Results

Abstract

To evaluate the stability of aneurysm occlusion over time, the need for additional treatments, and the long-term clinical outcome of patients, with emphasis on late recurrences of bleeding. The records of 160 patients with aneurysmal subarachnoid hemorrhage who were treated with coils were retrospectively reviewed. Follow-up angiography was performed 6 and 18 months after coil placement, and the results were classified as complete, near complete, and incomplete occlusion. Six (4%) of the 160 patients experienced procedural mortality or dependency. After a mean follow-up of 36 months, 134 (84%) patients had a good outcome. Outcome was independent of aneurysm size and location and timing of treatment. Reopening of the aneurysm occurred exclusively during the first 6 months after coil placement, mainly in aneurysms larger than 15 mm. Between 6 and 18 months, no change in aneurysm occlusion was observed. Additional coil placement was performed in 15 (9%) patients. After this second coil placement, nine (7%) aneurysms were still incompletely occluded. Additional therapy was performed in eight (5%) patients. Two recurrences of bleeding were observed in two incompletely occluded large aneurysms. No recurrences of bleeding occurred in patients with completely or near completely occluded aneurysms. Coil placement is an effective and safe treatment strategy for patients with aneurysmal subarachnoid hemorrhage. If aneurysm occlusion is sufficient at 6 months, the yield of further follow-up angiography is very low.