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Progressive thrombosis of unruptured aneurysms after coil embolization: analysis of 255 consecutive aneurysms

2019; BMJ; Volume: 11; Issue: 11 Linguagem: Inglês

10.1136/neurintsurg-2019-014775

1759-8486

Yusuke Funakoshi, Hirotoshi Imamura, Shoichi Tani, Hidemitsu Adachi, Ryu Fukumitsu, Tadashi Sunohara, Yoshihiro Omura, Yuichi Matsui, Natsuhi Sasaki, Tatsumaru Fukuda, Ryo Akiyama, Kazufumi Horiuchi, Shinji Kajiura, Masashi Shigeyasu, Nobuyuki Sakai,

Cerebrovascular and Carotid Artery Diseases

Introduction We have observed that aneurysms treated by insufficient coil embolization and filled with contrast agent immediately after the procedure are often completely occluded at follow-up. However, there are limited studies showing progressive thrombosis of aneurysms after coil embolization. Herein, we describe our experience with coil embolization for aneurysms, and discuss the factors involved in progressive thrombosis. Methods A total of 255 aneurysms treated by coil embolization in our institute between January 2011 and June 2017 and observed >6 months were included. ‘Progressive thrombosis’ indicated that aneurysms that were neck remnant (NR) or dome filling (DF) immediately after coil embolization changed to complete obliteration (CO) at the 6-month follow-up digital subtraction angiography. The factors involved in progressive thrombosis were assessed. Results In all aneurysms (n=255), 24 (9.4%) were CO, 82 (32.2%) were NR, and 149 (58.4%) were DF immediately after the procedure. At 6-month digital subtraction angiography, 123 (48.2%) were CO, 95 (37.3%) were NR, and 37 (14.5%) were DF. Retreatment for major recanalization was performed in eight cases (3.1%). One hundred and three aneurysms showed progressive thrombosis. There were significant differences in aneurysm location (P=0.0002), aneurysm dome diameter (P=0.0015), aneurysm neck diameter (P=0.0068), volume embolization ratio (P=0.0054), and endovascular procedure with stent (P=0.0264) between the progressive thrombosis and no thrombosis groups. Conclusions Progressive thrombosis can occur in aneurysms after coil embolization depending on aneurysm location and size, and stent use. Thus, the degree of coil embolization and combination with a stent should be adjusted depending on aneurysm type.