Treatment of multiple intracranial aneurysms with 1-stage coiling

Abstract

Background and purpose: Although multiple intracranial aneurysms are frequent, determining treatment strategy and methods for them is often complicated. The aim of this study was to evaluate the safety and effectiveness of 1-stage coiling for multiple intracranial aneurysms.

Materials and methods: All patients who underwent 1-stage coiling for ≥2 aneurysms were identified from a prospectively registered neurointerventional data base during 10 years. The patient characteristics and clinical and angiographic outcomes at discharge and follow-up were retrospectively evaluated.

Results: One hundred sixty-seven patients (male/female ratio, 30:137; mean age, 58 years) with multiple aneurysms (418 aneurysms; mean, 2.5 aneurysms/patient) underwent attempted 1-stage coiling for ≥2 aneurysms (359 aneurysms; mean, 2.1 aneurysms/patient). In 131 patients (78.4%), all detected aneurysms were treated with coiling only. Treatment-related morbidity and mortality at discharge were 1.8% and 0.6% per patient, respectively. Of the 132 patients without subarachnoid hemorrhage, 129 (97.7%) had favorable outcomes (mRS 0-2) at discharge; of the 35 patients with SAH, 27 (77.1%) had favorable outcomes at discharge. Of the 162 patients (97%) for whom clinical follow-up was available (mean, 35.8 months), 154 patients (95.1%) had favorable outcomes. Immediate posttreatment angiography showed complete occlusion in 186 (51.8%) aneurysms, neck remnants in 134 (37.3%), sac remnants in 33 (9.2%), and failure in 6 (1.7%). Of the 262 (73.9%) aneurysms that underwent follow-up imaging (mean, 24.8 months), 244 (93.1%) showed a stable or improved state, with 12 (4.6%) minor and 6 (2.3%) major recurrences.

Conclusions: One-stage coiling of multiple aneurysms seems to be safe and effective, with low morbidity and mortality.

Fig 1.

A 61-year-old woman presented with a Hunt and Hess scale grade 3 subarachnoid hemorrhage. Nonenhanced CT (not shown) showed a diffuse, nonlocalized, subarachnoid hemorrhage in the entire basal cistern. 3D reconstruction images of cerebral angiography reveal 3 similar-sized small aneurysms at the left superior cerebellar artery origin (A) and bilateral posterior communicating artery origin (B and C). Each of the 3 aneurysms also has an irregular shape with a daughter sac. The white arrowhead indicates a left tuberothalamic artery incorporated into the aneurysm sac. Postembolization control angiograms after balloon-assisted coiling for all 3 aneurysms show complete occlusion of the superior cerebellar artery (D) and the left posterior communicating artery (E) aneurysms, and an intentional neck remnant, from which a left tuberothalamic artery (black arrowhead) directly originated, of the right posterior communicating artery aneurysm (F).