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Neurosurgery:
doi: 10.1227/NEU.0b013e3182647a97
Technique Assessment

Does Stent Implantation Improve the Result of Repeat Embolization in Recanalized Aneurysms?

Cho, Young Dae MD*; Lee, Jong Young MD*; Seo, Jung Hwa MD*; Lee, Seung Jin MD*; Kang, Hyun-Seung MD, PhD; Kim, Jeong Eun MD, PhD; Son, Young Je MD, PhD; Jung, Keun-Hwa MD, PhD§; Kwon, O-Ki MD, PhD; Han, Moon Hee MD, PhD*,‡

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Abstract

BACKGROUND: Although endovascular technique and related devices continue to improve, recanalization of embolized aneurysm remains a pitfall of this approach. The problem of how to treat the recanalized aneurysm needs to be addressed.

OBJECTIVE: To determine the outcomes of patients undergoing repeat embolization for recanalized intracranial aneurysms and to evaluate the impact of stent implantation on subsequent recanalization.

METHODS: Between September 2001 and September 2011, we performed endovascular retreatment in 162 patients with a total of 197 recanalized intracranial aneurysms. Stent implantation was performed in 68 aneurysms during the retreatment. Clinical and morphological outcomes were assessed at 6 months or more after repeat embolization.

RESULTS: Procedure-related complications, including asymptomatic thromboembolism, occurred with 15 aneurysms (7.6%) without permanent neurological sequelae. Follow-up imaging of 172 aneurysms documented stable occlusion in 96 of the lesions (55.8%), minor recanalization in 17 (9.9%), and major recanalization in 59 (34.3%) during the mean follow-up period of 26.0 ± 18.0 months. In multiple logistic regression analysis, stent implantation was shown to reduce the major recanalization rate at 6 months after retreatment (odds ratio: 0.161; 95% confidence interval:, 0.038-0.670; P = .012) and thereafter (odds ratio: 0.226; 95% confidence interval: 0.088-0.581; P = .002).

CONCLUSION: Stent implantation, as well as compact coil packing, at the time of repeat embolization seems beneficial in reducing rates of further recanalization.

ABBREVIATION: MRA, magnetic resonance angi-ography

Copyright © by the Congress of Neurological Surgeons

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