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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Long-term results of endovascular treatment of intracranial aneurysms

Meeting Abstract

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  • Klaus Leber - Medizinische Universität, Graz, Univ. Klinik für Neurochirurgie, Graz, Austria
  • Günther Maderbacher - Universität Regensburg, Regensburg, Deutschland
  • Stefan Leber - Medizinische Universität, Graz, Graz, Austria
  • Verena Gellner - Medizinische Universität, Graz, Univ. Klinik für Neurochirurgie, Graz, Austria
  • Martin Wehrschütz - Medizinisches Universität Graz, Klinische Abteilung für Neuroradiologie, vaskuläre und interventionelle Radiologie, Graz, Austria
  • Günther Erich Klein - Medizinische Universität Graz, Graz, Austria

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.05.07

doi: 10.3205/17dgnc030, urn:nbn:de:0183-17dgnc0309

Published: June 9, 2017

© 2017 Leber et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Mid-term results of endovascular treatment of intracranial aneurysms yielded promising results. Our study focuses on the long-term results in terms of efficiency, recurrence rates and overall complications over more than a decade.

Methods: We included 131 patients with intracranial aneurysms (74 with ruptured and 57 with unruptured aneurysms). In total, 159 aneurysms were treated by endovascular coiling during a period from 1992 to 1999. Endpoints according to treatment related morbidity and mortality (Glasgow Outcome Scale, modified Rankin Scale) were recorded as well as radiological data according to occlusion rates could be obtained after a mean follow-up of twelve years.

Results: Treatment related mortality was found in 5.3% (7/131), four of these patients had a ruptured aneurysm. Treatment related morbidity was 9.2% (11/131) in patients with unruptured and 12.9% (17/131) with ruptured aneurysms, respectively. A primary total occlusion of the lesion could be achieved in 66% (105/159). In 46.7% (49/105) of the aneurysms a recurrence was noted on average after 3.8 years. Consequences of recurrent aneurysms were further embolization (44.9%), clipping (8.7%) and close observation (46.4%). Recurrences were more often detected in large aneurysms (p<0.05). Re-recurrences were seen in 70% (14/20) after a successful re-treatment.

Conclusion: Long-term stability of endovascular coiling seems not to be as guaranteed as of microsurgical clipping. Especially, large aneurysms need to be observed meticulously for the long run. It seems to be evident that the additional use of stents and/or flow-diverters will help to lower the recurrence rates in the endovascular field. The actual mortality rate in this series reflects to the fact that initially poor grade patients were treated rather by endovascular methods at times.