Importance of independent evaluation of initial anatomic results after endovascular coiling for ruptured cerebral aneurysms

Abstract

Initial incomplete occlusion is been an important predictor of aneurysm recurrence, rebleeding or retreatment after endovascular coiling. In 129 patients in the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) cohort, ruptured aneurysms were coiled within 14days of onset, and initial post-coiling and 1-year follow-up aneurysm-occlusion status were evaluated by both local investigators and independent reviewers. The aim of this study was to investigate whether self-reported evaluations of initial aneurysm occlusion by treating physicians predicted incomplete aneurysm occlusion at 1year after coiling for ruptured cerebral aneurysms as well as that done by independent evaluations. The relationships between self-reported or independent evaluations of initial anatomic results and 1-year incomplete aneurysm occlusion (retreatment within 1year, or residual aneurysms at 1year) were determined. Both initial and 1-year aneurysm-occlusion status were judged significantly worse by independent reviewers than by local investigators (p<0.001). One-year incomplete aneurysm occlusion was identified in 59 patients: 10 patients, including two patients with re-ruptured aneurysms, were retreated and 49 other patients were judged to have residual aneurysms by independent reviewers. On immediate post-coiling angiograms, both residual neck or aneurysm judged by local investigators, and residual aneurysm judged by independent reviewers, were predictive for 1-year incomplete aneurysm occlusion on univariate analyses. However, multivariate analyses found that the initial aneurysm occlusion status judged by independent reviewers (p=0.02, odds ratio=2.83, 95% confidence interval=1.15-6.95), but not by local investigators, was a significant predictor for 1-year incomplete aneurysm occlusion. This study demonstrates the importance of independent evaluations of aneurysm occlusion status for management of coiled aneurysms.