1 / 16

Follow-up of patients after aneurysm embolotherapy with coils

Follow-up of patients after aneurysm embolotherapy with coils. L Pyysalo,, L Keski-Nisula, T Niskakangas, V Kahara, J Öhman Tampere University Hospital, Tampere Finland. 617 patients with aneurysms treated 1992 – 1999 200 aneurysms in 185 patients were coiled

alicia
Télécharger la présentation

Follow-up of patients after aneurysm embolotherapy with coils

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Follow-up of patients after aneurysm embolotherapy with coils L Pyysalo,, L Keski-Nisula, T Niskakangas, V Kahara, J Öhman Tampere University Hospital, Tampere Finland

  2. 617 patients with aneurysms treated 1992 – 1999 200 aneurysms in 185 patients were coiled Clinical and angiographic outcome studied in 2007 - 2008 Follow-up 8 – 16 years after the initial coiling (or re-coiling) Mean follow-up time 11 years Patients and methods

  3. Patients and methods • 109 (/185) patients coiled after SAH and • 76 (/185) patients unruptured aneurysms • 122 patients still alive for delayed follow-up • Clinical outcome evaluated in 116 (95%) • MRI/MRA in 77 (63%) patients with 84 aneurysms

  4. Patients and methods • Glasgow Outcome Score (I –V) • -by clinical evaluation (77) or by phone interview (39) • MRA with non-contrast 3D-TOF and cross-sectional MRI (T1, Flair, T2*) • The same head-coil (1-channel) and the same (upgraded) 1.5T magnet (GE Signa) in follow-up as in the initial post-treatment MRAs (concurrently with the primary DSA or within one year) • (Kähärä et al.,AJNR Sept 1999)

  5. Methods • Three readers for all angiograms (diagnostic, procedural and follow-up) • Consensus statement of the occlusion grade: • 1) complete, 2) neck remnant, 3) incomplete • Initial aneurysm size, dome/neck ratio, location, coil packing density (”loose” or ”dense”)

  6. Results • In ruptured aneurysms the primary coil packing denser in DSA than in unruptured aneurysms (0.04). • No difference in achieved occlusion grades between ruptured and unruptured aneurysms in primary DSA. • In follow-up more ”incomplete” occlusions in MRA in the unruptured aneurysms (0.03). • Re-treatment provided for 25% ruptured and 21% unruptured aneurysms, mainly within six months

  7. Angiographic results Initial occlusion grade* Occlusion in follow-up Complete: 38 38 Neck remnant: 19 22 Incomplete: 27 23 (5/15% ruptured) Total: 84 83 (1 not diagnostic) • *Includes the grades achieved also after recoilings

  8. Stability in follow-up • Stable occlusion grade: 50 (ruptured/unr 20+30) • Occlusion improvement: 14(ruptured/unr 7+7) • Occlusion worsening: 19 (ruptured/unr 7+12) • Total 83 (34+49)

  9. Clinical outcome Ruptured Unruptured Total GOS V: 34 31 65 GOS IV: 12 16 28 GOS III: 13 9 22 GOS II: 1 0 1 GOS I: 0 0 0 Total 60 56 116 In only 3 patients without haemorrhage the poor outcome was related to aneurysm

  10. Clinical outcome – (re)bleedings • Alltogether 10 haemorrhages • - 1/75 unruptured (giant) aneurysm bled after 7 y • - 9/109 rebleedings in SAH patients • - except one rebled patient the others (9) died • - only 3 of rebled aneurysms were monitored by MRA (elderly, vegetative, lost to follow-up etc.) • - 5 initially as ”incomplete”, 3 ”neck remnants” (DSA) • Annual rebleeding rate 1.3 % in ruptured and • bleeding rate 0.1% in unruptured aneurysms

  11. Summary • Primarily: 38(46%) complete and 27(32%) incomplete • Follow-up: 38(46%) complete and 23(27%) incomplete • Annual rebleeding 1.3% (0.1% for unruptured) • - barely platinum coils were used - no stents, bioactive coils, balloon assistance etc. in the 1990`s • Conclusion: Coiled aneurysms remain relatively stable in long-term follow-up

  12. Angiographic results - stability • 20 (59%) aneurysms stable in SAH patients • 6 (18%) remnant growth and 1 recurrence (?) • 7 (21%) occlusion progression • In unruptured aneurysms: • 6 stable • 6 remnant growth and 6 recurrences (?) • 7 occlusion progression

  13. MRA results in follow-up • Complete occlusion in 18 (53%)+20 (40%) = 38 • Neck remnant: 11/32%+11/22% = 22 • Incomplete occlusion in 5/15% + 18/38% = 23 • Ruptured in bold

  14. Clinical outcome • Patients with unruptured aneurysms: • GOS 5: 55% (31) • GOS 4: 29% (16 patients) • GOS 3: 16% (9 patients were ”dependent”) • Only in 3 patients poor outcome was related to aneurysm

More Related