Abstract W P72: Coiling of Large and Giant Aneurysms: Complications and Long-Term Results of 334 Cases
Background and purpose: Despite increasing and widespread use of endovascular techniques, little is known about the morbidity rates, rehemorrhage rates, and long-term angiographic results of coiling in large and giant aneurysms. In addition, predictors of treatment outcome have not been identified. In this study, we analyze the complications and long-term results of coiling in the largest series of large and giant aneurysms (≥ 10 mm) to date.
Material and Methods: A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Aneurysm size was 15 mm on average. 225 aneurysms were treated with conventional coiling, 88 with stent-assisted coiling, 14 with parent vessel occlusion, and 7 with balloon-assisted coiling.
Results: Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33% respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome.
Conclusion: Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared to conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.
Author Disclosures: N. Chalouhi: None. S. Tjoumakaris: None. L. Gonzalez: None. A. Dumont: None. R. Starke: None. D. Hasan: None. C. Wu: None. S. Singhal: None. R. Rosenwasser: None. P. Jabbour: None.
- © 2014 by American Heart Association, Inc.