Long-term follow-up of intra-aneurysmal coil embolization for unruptured paraclinoid aneurysms.

OBJECTIVES

The selection of therapeutic modalities, including endovascular coil embolization and surgical clipping, for management of unruptured paraclinoid aneurysms, remains controversial. Detailed long-term outcome data for endovascular coil embolization of unruptured paraclinoid aneurysms are still lacking. Thus, we evaluated the safety and efficacy of coil embolization of unruptured paraclinoid aneurysms.

METHODS

From January 1998 to July 2010, 138 patients underwent endovascular coiling for 140 unruptured paraclinoid aneurysms. Their medical records and radiologic images were reviewed retrospectively.

RESULTS

Complications occurred in 5·7% of 140 procedures and the morbidity rate was 0·7%. Of the 140 unruptured paraclinoid aneurysms, a total of 111 aneurysms underwent follow-up imaging evaluation at 2 years or more, or showing reopening on imaging studies within 2 years (65·6±37·2 months). Multivariate analysis revealed two predictors for reopening of the aneurysms: a maximum diameter of aneurysms and a dome/neck ratio of aneurysms (P<0·05). Reopening rates of aneurysms with maximum sizes of <8, 8-10, and >10 mm were 1%, 25%, and 75%, respectively. Reopening rates were significantly different among the three groups (P<0·05). In aneurysms with a maximum diameter of 8-10 mm, there was a significant difference of dome/neck ratios between the presence and absence of reopened aneurysms (P<0·05).

DISCUSSION

The results indicate that endovascular coil embolization is a safe and effective treatment modality in selected patients with unruptured paraclinoid aneurysms. Consideration of the aneurysm size and the dome/neck ratio could assist in the selection of therapeutic modalities for these aneurysms.