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  • Long-Term Follow-up Angiography is Indicated after Coiling of Intracranial Aneurysms

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    Nohra Chalouhi MD; Cory Donovan Bovenzi; Vismay Thakkar MBBS; Jeremy Dressler; Pascal Jabbour MD; L. Fernando Gonzalez MD; Robert M. Starke MD MSc; Aaron S. Dumont MD; Robert H. Rosenwasser MD, FACS, FAHA; Stavropoula I. Tjoumakaris MD

    Study Design:

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    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Aneurysm recurrence remains the major shortcoming of coiling in intracranial aneurysms. The need for long-term imaging follow-up has been recently questioned. We assess the diagnostic yield of long-term follow-up digital subtraction angiography (DSA) and determine the predictors of delayed aneurysm recurrence.

    Methods: Inclusion criteria were: 1) Available short-term and long-term follow-up DSA (>36 months), and 2) no aneurysm recurrence or only minor recurrence (not requiring further intervention i.e. <20%) on short-term follow-up DSA.

    Results: Of 209 patients included in the study, 88 (42%) were initially treated in the setting of subarachnoid hemorrhage. On short-term follow-up angiography, 158 (75%) aneurysms showed no recurrence and 51 (25%) showed minor recurrence (not retreated). On long-term follow-up angiography, 124 (59%) aneurysms showed no recurrence while 85 (41%) aneurysms showed a recurrence requiring further intervention in 55 (26%). In multivariate analysis, the predictors of recurrence on long-term follow-up angiography were 1) larger aneurysm size (p=0.001), 2) male gender (p=0.006), 3) conventional coiling (p=0.05), 4) aneurysm location (p=0.01), and 5) a minor recurrence on short-term follow-up angiography (p=0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up angiography for detecting delayed aneurysm recurrence was only 40.0%

    Conclusions: The results of this large study challenge the conclusions of recent reports and suggest that long-term follow-up angiography is mandatory after coiling of intracranial aneurysm. Patients with large aneurysms, patients with a minor recurrence on short-term follow-up angiography, patients treated with conventional coiling, and male patients benefit the most from long-term follow-up angiography.

    Patient Care: Recent studies (using MRA) have seriously questioned the yield of long term follow-up angiography after coiling. We hereby provide evidence that the risk of delayed aneurysm recurrence is high following coiling and necessitates adequate long term follow-up. We also identify the group of patients in whom long term follow-up DSA has the highest diagnostic yield.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the diagnostic yield and understand the importance of performing long-term follow-up DSA. 2) Discuss predictors of delayed aneurysm recurrence and identify the group of patients that benefits the most from long term follow-up DSA. 3) Optimize the follow-up of patients undergoing aneurysm coiling.


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