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AJNR - American Journal of Neuroradiology

Published ahead of print on March 19, 2009
doi: 10.3174/ajnr.A1488

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American Journal of Neuroradiology 30:1035-1040, May 2009
© 2009 American Society of Neuroradiology

INTERVENTIONAL

Clinical and Angiographic Follow-up of Ruptured Intracranial Aneurysms Treated with Endovascular Embolization

R.A. Willinsky^a, J. Peltz^a, L. da Costa^a,b, R. Agid^a, R.I. Farb^a and K.G. terBrugge^a

^a Division of Neuroradiology Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Canada
^b Division of Neurosurgery (L.d.C.), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

Please address correspondence to Robert A. Willinsky, MD, 399 Bathurst St, 3MC-427, Toronto, ON, Canada, M5T 2S8; e-mail: robert.willinsky{at}uhn.on.ca

BACKGROUND AND PURPOSE: Endovascular embolization is a well-established treatment of ruptured intracranial aneurysms, but concern about its long-term stability and its ability to prevent rehemorrhage are still present. We evaluated the long-term clinical and angiographic follow-up of patients with ruptured cerebral aneurysms treated with coiling, focusing on rehemorrhage and changes in aneurysm morphologic features.

MATERIALS AND METHODS: A total of 377 patients with ruptured aneurysms that were treated with endovascular approaches at our institution between 1994 and 2008 were reviewed. Clinical and angiographic data were analyzed from a prospectively collected data base.

RESULTS: There were 377 patients with 391 ruptured aneurysms treated for 14 years. Good outcome (Glasgow Outcome Score [GOS], 5) was achieved in 74% of patients, moderate disability or poor outcome in 18%, and 8.8% died. Permanent morbidity or mortality from procedural complications occurred in 2.9%. Complete follow-up was available for 85% of surviving patients, with mean follow-up of 22.3 months. Re-treatment was required in 11% (31 patients). Eight (2.1%) patients had rebleeding, 6 (1.6%) in the hospital within 30 days of treatment, 5 in the first 48 hours. Follow-up imaging was available in 276 aneurysms in 270 patients. Recanalization occurred in 56 of 276 aneurysms (20.3%) regardless of the initial angiographic result, but the risk was higher if a body remnant was left (², 11.791; P = .0006).

CONCLUSIONS: Long-term clinical and angiographic follow-up demonstrates the efficacy of endovascular treatment of ruptured intracranial aneurysms. Rebleeding after treatment is rare, with the greatest risk during the first 48 hours after treatment. Initial angiographic results are not a useful predictor of clinical outcome or rehemorrhage.

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