Factors Associated with Major Re-Recanalization following Second Coiling for Recanalized Aneurysms: A Multicenter Experience over 20 Years during Long-Term Follow-up

Illustrative cases. R group case: A 73-year-old woman who had undergone coil embolization for an incidentally detected unruptured posterior communicating aneurysm with a maximum and neck diameter of 6.7 mm (A). An 8F balloon-guiding catheter (Merci; Stryker Neurovascular) was directed into the extracranial segment of the left ICA. The coils were inserted into the aneurysm using a double-catheter technique; no IMC, balloon, or stent was used, and the embolization result was RROC Class 2 (B). Major recanalization was discovered 27 months after the initial treatment (C). For the second coiling, 2 microcatheters (both Excelsior SL-10; Stryker Neurovascular) were navigated into the aneurysm for coil embolization. The coils were inserted into the aneurysm using a double-catheter technique and no IMC or stent was used. Ultimately, the coil embolization resulted in RROC Class 2 (D). No postoperative complications were noted, but major re-recanalization occurred 1 year after second coiling (E). NR group case: A 63-year-old woman who had undergone coil embolization for an incidentally detected unruptured cerebral aneurysm at the origin of the fetal posterior cerebral artery with a maximum diameter of 6.7 mm and a neck diameter of 5.0 mm (F). The coils were inserted into the aneurysm using a primary coiling; no IMC, balloon, or stent was used, and the embolization result was RROC Class 2 (G). Major recanalization was discovered 104 months after the initial treatment (H). A 6F guiding sheath (Asahi Fubuki; Asahi Intecc) was directed into the extracranial segment of the left ICA. A 3.2F Tactics catheter as the IMC was then guided coaxially to the supraclinoid segment of the left ICA. One microcatheter (Phenom 17; Medtronic) was navigated from the Tactics catheter into the aneurysm for coil embolization, and the other microcatheter (Excelsior SL-10) was directed into the left fetal posterior cerebral artery for stent placement. A Neuroform Atlas (Stryker Neurovascular) stent was placed from the left fetal posterior cerebral artery to the supraclinoid segment of the left ICA. Finally, the coil embolization achieved RROC Class 1 (I). No postoperative complications were noted, and follow-up DSA 1 year after the second coiling showed no re-recanalization (J). Subsequently, at 42 months, the patient remained without re-recanalization (image not shown).