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Neuroradiology |
1 From the Departments of Radiology (M.S., W.J.v.R.) and Neurosurgery (D.W.), St Elisabeth Ziekenhuis, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands; and Department of Neurology, University Medical Centre, Utrecht, the Netherlands (G.J.E.R.). Received June 4, 2002; revision requested July 30; final revision received September 27; accepted November 4. G.J.E.R. supported in part by grant D98.014 from the Netherlands Heart Foundation. Address correspondence to M.S. (e-mail: radiol@knmg.nl).
PURPOSE: To evaluate the stability of aneurysm occlusion over time, the need for additional treatments, and the long-term clinical outcome of patients, with emphasis on late recurrences of bleeding.
MATERIALS AND METHODS: The records of 160 patients with aneurysmal subarachnoid hemorrhage who were treated with coils were retrospectively reviewed. Follow-up angiography was performed 6 and 18 months after coil placement, and the results were classified as complete, near complete, and incomplete occlusion.
RESULTS: Six (4%) of the 160 patients experienced procedural mortality or dependency. After a mean follow-up of 36 months, 134 (84%) patients had a good outcome. Outcome was independent of aneurysm size and location and timing of treatment. Reopening of the aneurysm occurred exclusively during the first 6 months after coil placement, mainly in aneurysms larger than 15 mm. Between 6 and 18 months, no change in aneurysm occlusion was observed. Additional coil placement was performed in 15 (9%) patients. After this second coil placement, nine (7%) aneurysms were still incompletely occluded. Additional therapy was performed in eight (5%) patients. Two recurrences of bleeding were observed in two incompletely occluded large aneurysms. No recurrences of bleeding occurred in patients with completely or near completely occluded aneurysms.
CONCLUSION: Coil placement is an effective and safe treatment strategy for patients with aneurysmal subarachnoid hemorrhage. If aneurysm occlusion is sufficient at 6 months, the yield of further follow-up angiography is very low.
© RSNA, 2003
Index terms: Aneurysm, cerebral, 17.73 • Brain, hemorrhage, 17.434
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