Long-Term Prospective Follow-Up of Intracranial Aneurysms Treated with Endovascular Coiling Using Contrast-Enhanced MR Angiography

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Fig 1.
A, CE-MRA shows large recurrent class 3 aneurysm (arrow). B, Anteroposterior angiogram of the left ICA injection shows only minimal filling of the coiled aneurysm (arrow). C, Anteroposterior angiogram of the left ICA injection after recoiling (arrow) by using two 5 mm × 20 cm and 1 each of 4 mm ×10 cm, 3 mm× 8 cm, and 2 mm × 6 cm coils. This shows the helmet effect of coils, which obscures the filling of the coiled aneurysm on the conventional angiogram.
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Fig 2.
A and D, Axial base image of the CT angiography (A) performed at presentation of the patient shows an AcomA aneurysm, which is further confirmed on the subsequent conventional angiogram (D). B and E, The base image (B) and the MIP image (E) on CE-MRA performed 3 months after coiling show no evidence of residual filling. C and F, The base image (C) and the MIP image (F) on CE-MRA performed at 20 months' follow-up show a small amount of residual filling of the aneurysm near the neck, which can be more confidently seen compared with the base image of the initial CT angiogram (A).

Table 1:

Demographic data

	No. (%)
Patients	124 (30 men, 94 women; mean age, 55.4 years; range, 22–82 years)
Aneurysms	134
SAH	80 (59.7)
No SAH	54 (40.3)
Anterior circulation	97 (72.4)
AcomA	25 (18.7)
ICA	26 (19.4)
ACA	11 (8.2)
MCA	14 (10.5)
PcomA	21 (15.7)
Posterior circulation	37 (27.6)
Basilar tip	28 (20.9)
AICA	1 (0.8)
PICA	4 (2.9)
PCA	1 (0.8)
Vertebral artery	3 (2.2)
Stents (Neuroform)	18 (13.4)
Death	2 (1.6)
Lost to follow-up	11 (8.8)
Follow-up	111 (89.5)

Table 2:

CE-MRA: initial and follow-up results

	No. (%)
Initial obliteration
Class 1	67 (50)
Class 2	57 (42.5)
Class 3	8 (5.9)
Death	2 (1.6)
Lost to follow-up	11 (8.8)
Follow-up	111 (89.5)
Stable	76 (56.7)
Class 1	41 (30.6)
Class 2	26 (19.4)
Class 3	9 (6.7)
Unstable	56 (41.8)
Recanalization	47 (35.1)
Classes 1–2	20 (14.9)
Classes 1–3	6 (4.5)
Classes 2–3	21 (15.7)
Further obliteration	9 (6.7)
Classes 2–1	8 (5.9)
Classes 3–2	0
Classes 3–1	1 (0.8)
Recanalization to class 3 after coiling	27 (20.2)
<6 Months	16 (11.9)
6–12 Months	3 (2.3)
>12 Months	8 (5.9)
Retreatment	11 (8.2)