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Endovascular cerebral aneurysm treatment: Long term outcomes
Abstract
Introduction. The International Subarachnoid Aneurysm Trial confirmed endovascular treatment as the treatment of choice for intracranial ‘berry' aneurysms. The durability of coiling and the relevance of stable neck remnants needed to be addressed next. Methods. We retrospectively assessed the follow-up angiograms of patients who presented with subarachnoid haemorrhages or third-nerve palsies and had berry
aneurysms treated endovascularly between 2002 and 2003. Patients were phoned to assess their wellbeing and to see whether they were back at work or not.
Angiograms were assessed to ascertain the percentage of the aneurysm coiled at the initial procedure, and then stability was assessed by percentage change in the residual aneuysm
neck on later angiograms. Results. Over a 1-year period 75 patients were treated
endovascularly; 100% occlusion was achieved in 52% at the initial procedure, and although only 40 and 34 respectively attended for 3-month and 1-year follow-up angiograms there
was a trend toward progressive thrombosis in 65% and 82% respectively. In only 1 of the neck remnants was growth noted at the 3-month angiogram. One patient bled after missing
his 3-month follow-up angiogram. Although only 40% of the patients were contactable at 4 years there were no rebleeds among them. Conclusion. Coiling is durable, as shown by our results over a 4-year period, and while neck remnants that look unchanged are generally stable any growth should be viewed as grounds for concern and treated either endovascularly or surgically if required. The 5-year angiogram may be unnecessary, which
is of importance in our setting where socio-economic factors influence patient follow-up.
South African Medical Journal Vol. 98 (12) 2008: pp. 954-957
