Endovascular treatment of recurrent intracranial aneurysms with re-coiling or covered stents.

ABSTRACT

OBJECTIVE: To report our experiences in the treatment of recurrent intracranial aneurysms with re-coiling or covered stents. METHODS: A total of 291 patients with 305 intracranial aneurysms were treated with detachable coils, and 41 (28.9%) of 142 patients with aneurysms in the internal carotid artery had a recurrent aneurysm during the follow-up period. For this study, 31 recurrent aneurysms in 31 patients who had angiograms within 6 months following retreatment with detachable coils (group A, n = 20) or covered stents (group B, n = 11) were analysed. Aneurysms were categorised as complete or incomplete occlusion via angiographic assessment and graded as full recovery, improvement, no change or deterioration via clinical assessment. Data regarding technical success, initial and final angiographic results, mortality, morbidity and final clinical outcome were collected and analysed postoperatively. RESULTS: Coil embolisation and covered stent placement were technically successful in all recurrent aneurysms. The initial angiographic results showed complete occlusion in 11 patients (55%) in group A and in eight (72.7%) in group B (p = 0.452), and the final angiographic results exhibited complete occlusion in 10 patients (50%) in group A and in 11 (100%) in group B (p = 0.005). There were no significant differences in technique success, mortality, culminate morbidity or final clinical outcome between the two groups. CONCLUSIONS: Recurrent aneurysms after coiling can be successfully treated and occluded with re-coiling or covered stent placement. However, covered stents seem to be more effective than re-coiling with regard to complete occlusion of recurrent aneurysms.