Does Stent Implantation Improve the Result of Repeat Embolization in Recanalized Aneurysms?

Abstract

BACKGROUND: Although endovascular technique and related devices continue to improve, recanalization of embolized aneurysm remains a pitfall of this approach. The problem of how to treat the recanalized aneurysm needs to be addressed. OBJECTIVE: To determine the outcomes of patients undergoing repeat embolization for recanalized intracranial aneurysms and to evaluate the impact of stent implantation on subsequent recanalization. METHODS: Between September 2001 and September 2011, we performed endovascular retreatment in 162 patients with a total of 197 recanalized intracranial aneurysms. Stent implantation was performed in 68 aneurysms during the retreatment. Clinical and morphological outcomes were assessed at 6 months or more after repeat embolization. RESULTS: Procedure-related complications, including asymptomatic thromboembolism, occurred with 15 aneurysms (7.6%) without permanent neurological sequelae. Follow-up imaging of 172 aneurysms documented stable occlusion in 96 of the lesions (55.8%), minor recanalization in 17 (9.9%), and major recanalization in 59 (34.3%) during the mean follow-up period of 26.0 ± 18.0 months. In multiple logistic regression analysis, stent implantation was shown to reduce the major recanalization rate at 6 months after retreatment (odds ratio: 0.161; 95% confidence interval:, 0.038-0.670; P = .012) and thereafter (odds ratio: 0.226; 95% confidence interval: 0.088-0.581; P = .002). CONCLUSION: Stent implantation, as well as compact coil packing, at the time of repeat embolization seems beneficial in reducing rates of further recanalization.