Recanalized intracranial aneurysm

Large aneurysm neck size, wide neck morphology, large aneurysm diameter and ruptured aneurysm are significant predictors for recanalization of coiled aneurysms. Following endovascular treatment, ruptured intracranial aneurysms had a significantly increased risk of recanalization compared to matched unruptured intracranial aneurysms. The degree of recanalization of ruptured aneurysms is more significant and a higher percentage require retreatment. It takes a significantly shorter time for recanalization to occur in ruptured aneurysms compared to unruptured aneurysms. After endovascular treatment earlier, more frequent imaging follow-up is required for ruptured aneurysms compared to unruptured aneurysm 1).

Endovascular treatment of intracranial aneurysms can be technically challenging in cases of wide aneurysm necks or unfavorable aneurysm dome-to-neck ratio. Coils deployed without supporting devices may herniate from the aneurysm sac into the parent artery, causing thromboembolic complications or vessel occlusion. Therefore, alternative strategies for managing wide-necked aneurysms have been introduced such as Stent-assisted coiling (SAC), balloon assisted coiling (BAC), and double-catheter coil embolization (DCC).

Aneurysm size remains the most important predictor of aneurysm recanalization and retreatment after stent-assisted coiling. Although higher packing densities were associated with increased rates of aneurysm occlusion in unadjusted statistical comparisons, this finding was no longer significant after adjusting for confounders 2).

Stent implantation reduced the overall recanalization of the coiled cerebral aneurysms 3).

see Aneurysm Recanalization Stratification Scale.

The drawback of endovascular treatment is aneurysmal remnants or recurrences, which is safely and durably amenable to flow diversion 4).

Tan IY, Agid RF, Willinsky RA. Recanalization rates after endovascular coil embolization in a cohort of matched ruptured and unruptured cerebral aneurysms. Interv Neuroradiol. 2011 Mar;17(1):27-35. Epub 2011 Apr 18. PubMed PMID: 21561556; PubMed Central PMCID: PMC3278032.
Griessenauer CJ, Adeeb N, Foreman PM, Gupta R, Patel AS, Moore J, Abud TG, Thomas AJ, Ogilvy CS, Baccin CE. Impact of Coil Packing Density and Coiling Technique on Occlusion Rates for Aneurysms Treated with Stent-Assisted Coil Embolization. World Neurosurg. 2016 Oct;94:157-166. doi: 10.1016/j.wneu.2016.06.127. Epub 2016 Jul 9. PubMed PMID: 27402438.
Cho WS, Hong HS, Kang HS, Kim JE, Cho YD, Kwon OK, Bang JS, Hwang G, Son YJ, Oh CW, Han MH. Stability of Cerebral Aneurysms After Stent-Assisted Coil Embolization: A Propensity Score-Matched Analysis. Neurosurgery. 2015 Aug;77(2):208-16; discussion 216-7. doi: 10.1227/NEU.0000000000000759. PubMed PMID: 25839376.
Akgul E, Onan HB, Islek I, Tonge M, Durmus Y, Barburoglu M, Azizova A, Erol C, Hakyemez B, Sencer S, Aydin K, Arat A. Flow diverters in the treatment of recanalized intracranial aneurysms. Interv Neuroradiol. 2021 Jan 28:1591019921990507. doi: 10.1177/1591019921990507. Epub ahead of print. PMID: 33509011.
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