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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*,‡

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

Author Information

Departments of *Radiology

Neurosurgery, and

§Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea

Correspondence: Hyun-Seung Kang, MD, PhD, Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul, Korea, 110-744. E-mail: hsk4428@yahoo.com

Received December 11, 2011

Accepted May 30, 2012

Copyright © by the Congress of Neurological Surgeons