Abstract Body: Objective:
Recanalized aneurysms may still recanalize despite a second coiling to prevent rupture. Factors related to recanalization following a second coiling for recanalized aneurysms have not yet been fully explored. This study examined a large multicenter dataset accumulated over a 20-year period to identify factors related to major recanalization following a second coiling for recanalized aneurysms.
Methods:
A total of 185 patients with 188 aneurysms who underwent second coiling for saccular unruptured cerebral aneurysms at three institutions between November 2003 and December 2023 were retrospectively reviewed. Patients were categorized into a group with major recanalization (R group) and a group without major recanalization (NR group). To identify factors related to major recanalization, clinical, anatomic, and procedural factors were comparable between groups by multivariate logistic regression analysis and stepwise selection.
Results:
During the follow-up period (mean, 62.3 ± 51.2 months), 72 (38.3%) of 188 recanalized aneurysms developed major recanalization. Compared with the NR group, the R group had significantly larger aneurysm size, neck size, and aneurysm volume at initial coiling and significantly lower rates of stent-assisted coiling, use of an intermediate catheter, and complete occlusion at second coiling. Stepwise multivariate logistic regression analysis identified neck size at initial coiling (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.03–1.32) as an independent risk factor for major recanalization and stent-assisted coiling (OR 0.34; 95%CI 0.14–0.85), use of an intermediate catheter (OR 0.38; 95%CI 0.17–0.86), and complete occlusion at second coiling (OR 0.16; 95%CI 0.034–0.72) as independent protective factors for major recanalization.
Conclusions:
Second coiling of recanalized aneurysms may decrease the risk of major recanalization by using a stent in combination with an intermediate catheter to achieve complete occlusion.