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AJNR - American Journal of Neuroradiology

Published ahead of print on June 26, 2008
doi: 10.3174/ajnr.A1181

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Stability of Intracranial Aneurysms Adequately Occluded 6 Months after Coiling: A 3T MR Angiography Multicenter Long-Term Follow-Up Study

M.E. Sprengers^a,b, J. Schaafsma^c, W.J. van Rooij^a, M. Sluzewski^a, G.J.E. Rinkel^c, B.K. Velthuis^c, J.C. van Rijn^b and C.B. Majoie^b

^a Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
^b Department of Radiology, Academisch Medisch Centrum, Amsterdam, the Netherlands
^c Department of Radiology, Universitair Medisch Centrum, Utrecht, the Netherlands

View larger version (27K): [in this window] [in a new window]   Fig 1. Flow chart of total cohort and included aneurysms.

View larger version (152K): [in this window] [in a new window]   Fig 2. A 61-year-old woman with a ruptured 3-mm middle cerebral artery aneurysm. A, Precoiling angiogram shows a small aneurysm. B, Complete occlusion after coiling. C, Stable complete occlusion at 6 months. D, MRA at 7.3 years demonstrates a 1 x 2 mm intraluminal opening inside the coil mesh classified as a recurrence (arrow).

View larger version (131K): [in this window] [in a new window]   Fig 3. A 54-year-old woman with a ruptured 5-mm basilar tip aneurysm. A, Precoiling vertebral angiogram shows a basilar tip aneurysm. B, Stable complete occlusion at 6 months. C, Angiogram at 5.8 years shows a 2 x 3 mm disklike recurrence at the base of the aneurysm. D, MRA at 8.0 years is unchanged, compared with the last angiogram.

View larger version (152K): [in this window] [in a new window]   Fig 4. A 49-year-old woman with a ruptured 10-mm basilar tip aneurysm. A, Precoiling vertebral angiogram demonstrates the basilar tip aneurysm with a small bleb on its base (arrow). B, On the angiogram immediately postcoiling, the bleb (arrow) is not occluded. C, Unchanged open bleb (arrow) at 6 months. D, Angiogram at 5.5 years with recurrence (arrow) at the base from the bleb. E and F, MRA overview (E) and detail (F) at 8.1 years demonstrate unchanged recurrence (arrow).

View larger version (83K): [in this window] [in a new window]   Fig 5. A 66-year-old man presenting with seizures with an unruptured left middle cerebral artery aneurysm. A, Precoiling angiogram. B, Complete occlusion after coiling. C, Stable complete occlusion at 6 months. D, MRA at 6.6 years shows a 6 x 4 mm recurrence (arrow). E, Angiogram before the second coiling. F, After the second coiling, again complete occlusion is seen. G, Six months after the second coiling, repeat reopening of the aneurysm is noted. H, After the third coiling, again complete occlusion is seen. Note that the coil mesh is much larger than the aneurysmal lumen in A. I, Initial CT angiography before the first coiling demonstrates thrombus surrounding the aneurysm lumen and perifocal edema. J, MR imaging at 6.6 years shows migration of the coil mesh in the thrombosed part of aneurysm and a perianeurysmal cyst.