News | Stroke | June 12, 2015

Aneurysms May Recur Years after Endovascular Treatment

Magnetic resonance angiography suggests incomplete occlusion and large lesions are risk factors for long-term recurrence

intracranial aneurysm, endovascular treatment, EVT, MRA, Naggara

June 12, 2015 - Endovascular treatment (EVT) of intracranial aneurysm is effective in preventing long-term bleeding, but may be followed by aneurysm recurrences in a significant proportion of cases, according to a study published online in the journal Radiology.

Intracranial aneurysm is a weak or thin spot in a blood vessel in the brain that balloons and fills with blood. It can leak or rupture, leading to a potentially fatal cerebral hemorrhage.

EVT with coils was developed in the 1990s and became an established treatment for intracranial aneurysm in the early 2000s. In EVT, coils are threaded via a micro-catheter through a blood vessel in the groin to the location of the aneurysm. The coils expand and cause formation of a clot in the aneurysm that provides a seal, or occlusion, to prevent further bleeding.

The main drawback of endovascular treatment is recanalization, or a return of blood flow into the original aneurysm. Previous studies on the clinical significance of this have followed a limited number of patients for relatively short periods.

For the new study, researchers looked at the long-term efficacy of EVT in preventing aneurysm ruptures. They performed clinical examination and 3-Tesla magnetic resonance angiography (MRA) 10 years after EVT of intracranial aneurysm in a single institution. In addition, they reviewed results from the medical literature to identify studies reporting bleeding and/or aneurysm recurrence rate in patients followed beyond 10 years after EVT.

Among 129 aneurysms followed for more than10 years, 16 (12.4 percent) demonstrated recanalization between midterm and long-term MRA. Incomplete occlusion on midterm MRA and retreatment within five years were risk factors for late recurrence. The literature review of 2,902 aneurysms showed that incomplete occlusion and aneurysm size of greater than 10 millimeters were risk factors for late recurrence.

The results show that while EVT is effective in preventing long-term bleeding, patients with larger aneurysms or incomplete occlusion face a long-term risk of aneurysm recurrences.

"This result is of importance since a large proportion of patients in the study were young, with a mean age of 47 years," said Olivier N. Naggara, M.D., Ph.D., from the Centre Hospitalier Sainte-Anne in Paris. "Consequently, demonstration of the efficacy of prevention of rupture more than 10 years after treatment is a crucial point."

If supported by additional research, the findings may mean that longer follow-up protocols are necessary for some intracranial aneurysm patients who undergo EVT.

"We believe that the subgroup of patients with aneurysm size 10 millimeters or more and patients with incomplete occlusions should be followed by noninvasive imaging exams for 10 years or more, particularly young patients," Naggara said.

EVT can be repeated to prevent a potential angiographic recurrence. However, more research is needed, Naggara said, to develop a clearer picture of the risks and benefits of this approach.

"Retreating a recurrent aneurysm with additional coils may fail in up to 50 percent of cases," he said. "Adjunctive techniques we add to standard coiling, such as modified coils, stents and flow diverters, have demonstrated lower recurrence rate after EVT but may involve more risks than simple treatment with platinum coils."

For more information: www.radiologyinfo.org

Related Content

Ultra-fast, less than one-minute scan time, cardiac MRI enables accurate assessment of heart anatomy and function, improves patient comfort, increases access to care, and reduces costs
News | Magnetic Resonance Imaging (MRI) | July 02, 2021
July 2, 2021 — Philips has participated in an important research project to develop a...
This study found cardiac MRI gadolinium-based contrast agents are safe for patient use. Overall, there were only 556 acute adverse effects in 145,855 contrast-enhanced MRIs, with only 47 being classified as severe.

This study found cardiac MRI gadolinium-based contrast agents are safe for patient use. Overall, there were only 556 acute adverse effects in 145,855 contrast-enhanced MRIs, with only 47 being classified as severe. 

Feature | Magnetic Resonance Imaging (MRI) | October 29, 2020
October 29, 2020 — Contrast agents used to improve views of the heart on magnetic resonance imaging (MRI) carry a ver
Chest X-ray, posteroanterior view, of a 79-year-old man with history of a previous pacemaker, with abandoned right atrial and right ventricular pacing leads on the right side at time of new cardiac resynchronization therapy defibrillator implant on the left side. Arrows indicate a nodular opacity in the right midlung concerning for mass. Find more images of patients in this study in Radiology: Cardiothoracic Imaging.

Chest X-ray from a patient included in the study. Posteroanterior view, of a 79-year-old man with history of a previous pacemaker, with abandoned right atrial and right ventricular pacing leads on the right side at time of new cardiac resynchronization therapy defibrillator implant on the left side. Arrows indicate a nodular opacity in the right midlung concerning for mass. Find more images of patients in this study in Radiology: Cardiothoracic Imaging.

Feature | Magnetic Resonance Imaging (MRI) | October 27, 2020
October 27, 2020 – Magn...
Cardiac MR, also called cardiac MRI or heart MRI, can offer data above and beyond anatomical imaging.

Cardiac MR can offer data above and beyond anatomical imaging, which is the main reason why this system was installed at Baylor Scott White Heart Hospital in Dallas. The system is a dedicated heart MRI scanner.

Feature | Magnetic Resonance Imaging (MRI) | February 19, 2020 | Dave Fornell, Editor
Videos | Magnetic Resonance Imaging (MRI) | December 20, 2019
James Carr, M.D., chair of the Department of Radiology, Northwestern University, and incoming 2020 President of the...
Greater Left Ventricular Mass Increases Risk of Heart Failure
News | Magnetic Resonance Imaging (MRI) | October 21, 2019
Elevated left ventricular mass, known as left-ventricular hypertrophy, is a stronger predictor of coronary artery...
Heart MRI example. An example of a cardiac MRI exam showing perfusion defects in the heart muscle, amount of infarct and edema and a score for myocardial salvage which can help determine if revasularization will help restore heart function.

A example of a cardiac MRI exam showing perfusion defects in the heart muscle, amount of infarct and edema and a score for myocardial salvage, which can help determine if revasularization will restore heart function following a heart attack.

News | Magnetic Resonance Imaging (MRI) | October 07, 2019
October 7, 2019 – A recent study published in the New England Journal of Medicine supports the use of
Machine Learning Could Offer Faster, More Precise Cardiac MRI Scan Results
News | Magnetic Resonance Imaging (MRI) | September 25, 2019
Cardiac magnetic resonance imaging (MRI) analysis can be performed significantly faster with similar precision to...
Haojie Wang, M.D., director of advanced cardiovascular MRI and a member of the heart valve clinic at Baylor Scott White Heart Hospital, Dallas. His hospital installed a dedicated cardiac Siemens 1.5T MRI scanner in 2018 because MRI offers soft tissue visualization not available on CT or ultrasound.

Haojie Wang, M.D., director of advanced cardiovascular MRI and a member of the heart valve clinic at Baylor Scott White Heart Hospital, Dallas. His hospital installed a dedicated cardiac Siemens 1.5T MRI scanner in 2018 because MRI offers soft tissue visualization not available on CT or ultrasound.

Feature | Magnetic Resonance Imaging (MRI) | September 06, 2019 | Jeff Zagoudis, Associate Editor
Traditionally, computed tomography (CT) and ultrasound have been the workhorse imaging modalities in the world of car