Immediate post-operative aneurysm occlusion after endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1189 patients: Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) Study.

Abstract

BACKGROUND:

Coiling, including balloon-assisted coiling (BAC), is the first-line therapy for ruptured and unruptured aneurysms. Its efficacy can be clinically evaluated by bleeding/rebleeding rate after coiling, and anatomically evaluated by aneurysm occlusion post-procedure and during follow-up. We aimed to analyze immediate post-coiling aneurysm occlusion and associated factors within the Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) population.

METHODS:

Between December 2013 and May 2015, 16 neurointerventional departments prospectively enrolled participants treated for ruptured and unruptured aneurysms (ClinicalTrials.gov: NCT01942512). Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. In patients with aneurysms treated by coiling or BAC, immediate post-operative aneurysm occlusion was independently evaluated by a core lab using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant.

RESULTS:

Of 1135 participants (age 53.8±12.8 years, 754 women (66.4%)), 1189 aneurysms were analyzed. Treatment modality was standard coiling in 645/1189 aneurysms (54.2%) and BAC in 544/1189 (45.8%). Immediate post-operative aneurysm occlusion was complete occlusion in 57.8%, neck remnant in 34.4%, and aneurysm remnant in 7.8%. Adequate occlusion (complete occlusion or neck remnant) was significantly more frequent in aneurysms with size <10 mm (93.1% vs 86.3%; OR 1.8, 95% CI 1.1 to 3.2; p=0.02) and in aneurysms with a narrow neck (95.8% vs 89.6%; OR 2.5, 95% CI 1.5 to 4.1; p=0.0004). Patients aged <70 years had significantly more adequate occlusion (92.7% vs 87.2%; OR 1.9, 95% CI 1.1 to 3.4; p=0.04).

CONCLUSIONS:

Immediately after aneurysm coiling, including BAC, adequate aneurysm occlusion was obtained in 92.2%. Age <70 years, aneurysm size <10 mm, and narrow neck were factors associated with adequate occlusion.

TRIAL REGISTRATION NUMBER:

NCT01942512, http://www.clinicaltrials.gov.

• Authors: Laurent Pierot, Coralie Barbe, Denis Herbreteau, Jean-Yves Gauvrit, Anne-Christine Januel, Fouzi Bala, Frédéric Ricolfi, Hubert Desal, Stéphane Velasco, Mohamed Aggour, Emmanuel Chabert, Jacques Sedat, Denis Trystram, Gaultier Marnat, Sophie Gallas, Georges Rodesch, Frédéric Clarençon, Chrysanthi Papagiannaki, Phil White, Laurent Spelle, From the Departments of Neuroradiology, Research, and Public Health
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 13 Issue 10 Pg. 918-923 (Oct 2021) ISSN: 1759-8486 [Electronic] England
• PMID: 33443137 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Adult
• Aged
• Aneurysm, Ruptured (diagnostic imaging, surgery)
• Embolization, Therapeutic (adverse effects)
• Endovascular Procedures (adverse effects)
• Female
• Humans
• Intracranial Aneurysm (diagnostic imaging, surgery)
• Middle Aged
• Prospective Studies
• Retrospective Studies
• Stents
• Treatment Outcome