Stability of ruptured intracranial aneurysms treated with detachable coils: is delayed follow-up angiography warranted?

Abstract

The optimal strategy for monitoring the stability of ruptured intracranial aneurysms following coil embolisation is unclear. The value of delayed follow-up angiography in detecting new recurrences or progression of residual lesions visualised on earlier angiographic studies was determined in the light of the increasing use of non-invasive imaging techniques such as time of flight magnetic resonance angiography (TOF-MRA) for the evaluation of intracranial aneurysm occlusion. Ninety-seven patients with 105 ruptured aneurysms treated with detachable coils in 2005 and 2006 were included. The presence of a residual neck or aneurysm was assessed on catheter angiograms performed at 6 months and 2 years using the Raymond criteria (Class I = completely occluded, class II = small residual neck, class III = aneurysm sac filling). At 6-month follow-up, 32% of class I aneurysms progressed to class II and 6% of these aneurysms required re-treatment. A further 2-year angiogram was obtained in 59 patients with 65 aneurysms. Ninety-six per cent of class I, 100% of the class II and class III aneurysms remained unchanged at 2 years compared to 6 months. In our series, most recurrences were apparent at 6-month follow-up. The vast majority of coiled ruptured aneurysms that were class I or II at 6 months remained stable at 2-year follow-up. In the absence of a residual lesion in the early angiographic study, a further delayed catheter angiogram may not be warranted. The use of non-invasive strategies such as TOF-MRA should be considered.

Key words:

• Delayed catheter angiogram
• ruptured intracranial aneurysms
• subarachnoid haemorrhage
• aneurysm recurrence

Author contributions

J. Tailor analysed the data and wrote the primary draft of the manuscript. P. Goetz contributed to analysing data and writing the article. T. Stephens contributed to data collection. H. Chandrasekhar reviewed all the angiograms independently and graded the aneurysm occlusion retrospectively. F. Robertson and S. Brew performed the catheter angiograms and revised the manuscript. M. Schiariti, L. Watkins and J. Grieve contributed to reviewing the manuscript. F. Robertson and N. Kitchen are the senior authors in the article and reviewed the final draft.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.