Characteristics of Unruptured Intracranial Aneurysms with Delayed Rupture Following Coil Embolization: Case Series and Review of the Literature

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  • Tachi Rintaro
    Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba, Japan
  • Fuga Michiyasu
    Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba, Japan
  • Tanaka Toshihide
    Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba, Japan
  • Teshigawara Akihiko
    Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba, Japan
  • Kajiwara Ikki
    Department of Neurosurgery, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
  • Irie Koreaki
    Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
  • Ishibashi Toshihiro
    Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
  • Hasegawa Yuzuru
    Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba, Japan
  • Murayama Yuichi
    Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan

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<p>Objective: Long-term clinical outcomes including delayed rupture of unruptured intracranial aneurysms (UIAs) after coil embolization (CE) remain unclear. The purpose of this study was to evaluate the precise timing of re-treatment for recanalized UIAs before rupture.</p><p>Methods: From February 2012 to June 2020, a total of 197 patients with 207 UIAs underwent CE in our institution and were followed up for more than 6 months. The follow-up period, as well as morphological changes from treatment to recanalization, regrowth, and rupture, was retrospectively analyzed. Delayed rupture was defined as a rupture that occurred more than 1 month after CE.</p><p>Results: The average length of follow-up was 48.7 months. Three of 207 UIAs (1.45%) ruptured after CE. The aneurysm locations were the middle cerebral artery (MCA), anterior communicating artery (AcomA), and internal carotid artery–posterior communicating artery (ICA–Pcomm). The annual rupture rate after CE was 0.36%. Immediately after the first CE, treated aneurysms were graded according to the Modified Raymond–Roy Classification with class II for MCA aneurysms and class IIIb for AcomA and ICA–Pcomm aneurysms. The ICA–Pcomm aneurysm was treated with two additional CEs and was finally graded as class I. In all cases, DSA or MRA before aneurysm rupture showed recanalization and regrowth of aneurysms. The average periods from final embolization to regrowth and from regrowth to rupture were 54.3 months (±16.8) and 2.3 months (±0.9), respectively.</p><p>Conclusion: UIAs with recanalization and regrowth after CE should undergo re-treatment as early as possible.</p>

収録刊行物

  • 脳神経血管内治療

    脳神経血管内治療 16 (8), 387-394, 2022

    特定非営利活動法人 日本脳神経血管内治療学会

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