RT Journal Article
SR Electronic
T1 Factors Associated with Major Re-Recanalization following Second Coiling for Recanalized Aneurysms: A Multicenter Experience over 20 Years during Long-Term Follow-up
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A8671
A1 Fuga, Michiyasu
A1 Ishibashi, Toshihiro
A1 Kan, Issei
A1 Aoki, Ken
A1 Tachi, Rintaro
A1 Irie, Koreaki
A1 Kato, Naoki
A1 Hataoka, Shunsuke
A1 Nagayama, Gota
A1 Sano, Tohru
A1 Tanaka, Toshihide
A1 Murayama, Yuichi
YR 2025
UL http://www.ajnr.org/content/early/2025/05/29/ajnr.A8671.abstract
AB BACKGROUND AND PURPOSE: Second coiling for recanalized aneurysms can mitigate the risk of delayed rupture, though re-recanalization may still occur. However, factors associated with re-recanalization after second coiling for recanalized aneurysms have yet to be adequately investigated. The present study explored a large, multicenter data set accumulated over 20 years to identify factors associated with major re-recanalization after second coiling for recanalized aneurysms.MATERIALS AND METHODS: We retrospectively reviewed 188 consecutive aneurysms in 185 patients who underwent second coiling for saccular recanalized aneurysms at 3 institutions from January 2003 to December 2023. Patients were classified into 2 groups: with major re-recanalization (R group) and without major re-recanalization (NR group). To identify factors associated with major re-recanalization, clinical, anatomic, and procedural characteristics were compared between the 2 groups by multivariate logistic regression analysis and stepwise selection.RESULTS: During follow-up (mean, 62.3 ± 51.2 months), 72 (38.3%) of the 188 recanalized aneurysms showed major re-recanalization. In univariate analysis, compared with the NR group, the R group showed significantly larger aneurysm size, neck size, and aneurysm volume at first coiling and lower rates of stent-assisted coiling, use of an intermediate catheter (IMC), and complete occlusion at second coiling. Stepwise multivariate logistic regression analysis revealed neck size at first coiling (OR 1.18; 95% CI: 1.04–1.33) as an independent risk factor and stent-assisted coiling (OR 0.34; 95% CI: 0.15–0.79), use of an IMC (OR 0.35; 95% CI: 0.16–0.80), and complete occlusion at second coiling (OR 0.16; 95% CI: 0.033–0.70) as independent protective factors for major re-recanalization.CONCLUSIONS: The main risk factor for major re-recanalization after second coiling of recanalized aneurysms was neck size at first coiling, and protective factors included stent-assisted coiling, use of an IMC, and complete occlusion at second coiling. Second coiling for recanalized aneurysms may reduce the risk of major re-recanalization by using a stent or IMC and achieving complete occlusion.GDCGuglielmi detachable coilHRhazard ratioIMCintermediate catheterIQRinterquartile rangeLTAlight transmission aggregometryLVISlow-profile visualized intraluminal supportNRnon-major re-recanalizationRmajor re-recanalizationROCreceiver operating characteristicRROCRaymond–Roy Occlusion ClassificationUCAunruptured cerebral aneurysmVERvolume embolization ratio