Defining the risk of retreatment for aneurysm Recurrence or residual after initial treatment by endovascular coiling: A multicenter study

Andrew J. Ringer, Rafael Rodriguez-Mercado, Erol Veznedaroglu, Elad I. Levy, Ricardo A. Hanel, Robert A. Mericle, Demetrius K. Lopes, Giuseppe Lanzino, Alan S. Boulos

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Objective: Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling. Methods: Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days). Results: Retreatment mortality was 0.85% per procedure and 0.96% per patient. Treatment-related rates were 0.32% per patient (0.28% per procedure) for permanent or temporary major disability; 1.29% for permanent minor disability (1.14% per procedure); and 1.61% for temporary minor disability (1.42% per procedure). Total risk for death or permanent major disability was 1.28% per patient and 1.13% per procedure. Conclusion: Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.

Original languageEnglish (US)
Pages (from-to)311-315
Number of pages5
JournalNeurosurgery
Volume65
Issue number2
DOIs
StatePublished - Aug 1 2009
Externally publishedYes

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Retreatment
Multicenter Studies
Aneurysm
Recurrence
Intracranial Aneurysm
Therapeutics
Morbidity
Puerto Rico
Risk Management
Hemorrhage
Mortality

Keywords

  • Aneurysm
  • Angiography
  • Coiling
  • Recurrence
  • Residual

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Ringer, A. J., Rodriguez-Mercado, R., Veznedaroglu, E., Levy, E. I., Hanel, R. A., Mericle, R. A., ... Boulos, A. S. (2009). Defining the risk of retreatment for aneurysm Recurrence or residual after initial treatment by endovascular coiling: A multicenter study. Neurosurgery, 65(2), 311-315. https://doi.org/10.1227/01.NEU.0000349922.05350.96

Defining the risk of retreatment for aneurysm Recurrence or residual after initial treatment by endovascular coiling : A multicenter study. / Ringer, Andrew J.; Rodriguez-Mercado, Rafael; Veznedaroglu, Erol; Levy, Elad I.; Hanel, Ricardo A.; Mericle, Robert A.; Lopes, Demetrius K.; Lanzino, Giuseppe; Boulos, Alan S.

In: Neurosurgery, Vol. 65, No. 2, 01.08.2009, p. 311-315.

Research output: Contribution to journalArticle

Ringer, AJ, Rodriguez-Mercado, R, Veznedaroglu, E, Levy, EI, Hanel, RA, Mericle, RA, Lopes, DK, Lanzino, G & Boulos, AS 2009, 'Defining the risk of retreatment for aneurysm Recurrence or residual after initial treatment by endovascular coiling: A multicenter study', Neurosurgery, vol. 65, no. 2, pp. 311-315. https://doi.org/10.1227/01.NEU.0000349922.05350.96
Ringer, Andrew J. ; Rodriguez-Mercado, Rafael ; Veznedaroglu, Erol ; Levy, Elad I. ; Hanel, Ricardo A. ; Mericle, Robert A. ; Lopes, Demetrius K. ; Lanzino, Giuseppe ; Boulos, Alan S. / Defining the risk of retreatment for aneurysm Recurrence or residual after initial treatment by endovascular coiling : A multicenter study. In: Neurosurgery. 2009 ; Vol. 65, No. 2. pp. 311-315.
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abstract = "Objective: Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling. Methods: Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days). Results: Retreatment mortality was 0.85{\%} per procedure and 0.96{\%} per patient. Treatment-related rates were 0.32{\%} per patient (0.28{\%} per procedure) for permanent or temporary major disability; 1.29{\%} for permanent minor disability (1.14{\%} per procedure); and 1.61{\%} for temporary minor disability (1.42{\%} per procedure). Total risk for death or permanent major disability was 1.28{\%} per patient and 1.13{\%} per procedure. Conclusion: Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.",
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AU - Veznedaroglu, Erol

AU - Levy, Elad I.

AU - Hanel, Ricardo A.

AU - Mericle, Robert A.

AU - Lopes, Demetrius K.

AU - Lanzino, Giuseppe

AU - Boulos, Alan S.

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N2 - Objective: Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling. Methods: Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days). Results: Retreatment mortality was 0.85% per procedure and 0.96% per patient. Treatment-related rates were 0.32% per patient (0.28% per procedure) for permanent or temporary major disability; 1.29% for permanent minor disability (1.14% per procedure); and 1.61% for temporary minor disability (1.42% per procedure). Total risk for death or permanent major disability was 1.28% per patient and 1.13% per procedure. Conclusion: Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.

AB - Objective: Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling. Methods: Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days). Results: Retreatment mortality was 0.85% per procedure and 0.96% per patient. Treatment-related rates were 0.32% per patient (0.28% per procedure) for permanent or temporary major disability; 1.29% for permanent minor disability (1.14% per procedure); and 1.61% for temporary minor disability (1.42% per procedure). Total risk for death or permanent major disability was 1.28% per patient and 1.13% per procedure. Conclusion: Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.

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KW - Angiography

KW - Coiling

KW - Recurrence

KW - Residual

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