Ten-year Experience of Endovascular Treatment for Ruptured Cerebral Aneurysms

Although endovascular coil embolizations have increased in number, open surgery is still predominant for the treatment of ruptured cerebral aneurysms in Japan, partly because there are not enough follow-up results of endovascular coil embolization to discuss long-term outcomes of the procedure. We retrospectively analyzed radiological and clinical results in patients with ruptured cerebral aneurysms treated with coil embolization. From 1997 to 2006, 100 patients with ruptured intracranial aneurysms were treated with endovascular coil embolization. Clinical records and radiological findings of all these patients were retrospectively checked till the end of 2007. Thirty-one patients were 70 years or over in age, and 39 patients were in WFNS grade IV or V on admission. Although this cohort was older and higher in WFNS grade than in other reports, initial and follow-up results were the same. Mean follow-up periods were 42.1 months. Fifteen patients died during follow-up, and 76 patients showed complete obliterations of the aneurysm by the initial procedure. We experienced 10 major recurrences that needed retreatment, and 1 patient suffered from rebleeding while a retreatment was scheduled. Seven recurrent aneurysms were 10 mm or more in diameter at the initial treatment. The second treatment was successfully performed in 5 patients without complications or recurrences during 38 months of mean follow-up after the second procedure. One patient with a large basilar tip aneurysm suffered from a late regrowth of the aneurysm at 2.5 years after an initial tight packing, for which 4 additional treatments were performed. Endovascular treatment of ruptured cerebral aneurysms with coils seems to have good clinical and radiological results. However, the risk of regrowth, which results in bleeding, may continue until late follow-up periods, particularly in aneurysms more than 10 mm. Retreatment should be considered as soon as possible when major recurrence, which permits additional coils, occurs.