Abstract 3747: Clinical And Imaging Outcomes For Target Aneurysm Retreatment For Remnant Intracranial Aneursym
Introduction: Aneurysmal subarachnoid hemorrhage (SAH) is a rare but devastating form of stroke. Currently surgical clipping and endovascular embolization are the two therapeutic options for treatment of intracerebral aneurysm. The reported complication rate associated with the initial endovascular treatment is about 2-40%. However, outcome and complications after target aneurysmal retreatment (TAR) is unknown. Our objective is to report clinical and imaging outcomes for TAR.
Design/Methods: We identified patients who underwent TAR from a hospital neurointerventional database. We collected data on demographics, peri-procedural complications, clinical and imaging outcomes at the discharge and last follow-up. Peri-procedural complications were reported as intra operative perforation (IOP), thromboembolic event (TEE), both were considered symptomatic if patient develop new neurological deficit lasting for increase in NIHSS . Length of hospital stay, modified Ranking Scale (mRS), discharge disposition, recurrent SAH, re-treatment of the same aneurysm, and mortality were measured at discharge and follow up appointments. Complete data was available for 115/155 (74%) cases.
Results: There were total of 155/1169 (13.3%) cases underwent TAR with mean age of 55 ( 3), 98 (63%) were females, and 118 (76%) were Caucasians. One hundred four (67%), had aneurysm located in the anterior circulation, 4/116 (3%) underwent TAR for recurrent acute SAH, 72/116 (62%) required stent and 10/116 (9%) required balloon assist. There were total of 5/115 (4%) IOP, and 8/115 (7%) TEE from which 2/115 (2%), and 1/115 (1%) were symptomatic respectively for a total of 3/115 (2.6%) patients. 117/151 (77%) had complete immediate obliteration of the aneurysm after TAR. Ninety five patients (83%) had mean length of hospital stay with 143/151 (95%) patients discharged home. At discharge 99/114 (87%) patients, had mRS with 0% mortality. Total of 90/155 (58%) patients had average follow up of 14 months with 8/90 (9%) requiring a 2nd TAR and 1/90 (1%) requiring 3rd TAR for recanalization. There was no re-rupture after the 1st TAR for the duration of follow-up period of 14 ( in total of 90 patients).
Conclusions: In our study the rate of symptomatic events following TAR after initial endovascular therapy is 3/115 (2.6%) with 77% obliteration rate and 0% re-repture rate. TAR after an initial endovascular treatment is safe with an acceptable rate of complications and may be effective, suggested by lower rate of re-rupture.
- © 2012 by American Heart Association, Inc.