Treatment of Multiple Intracranial Aneurysms with 1-Stage Coiling

Abstract

BACKGROUND AND PURPOSE: Although multiple intracranial aneurysms are frequent, determining treatment strategy and methods for them is often complicated. The aim of this study was to evaluate the safety and effectiveness of 1-stage coiling for multiple intracranial aneurysms.

MATERIALS AND METHODS: All patients who underwent 1-stage coiling for ≥2 aneurysms were identified from a prospectively registered neurointerventional data base during 10 years. The patient characteristics and clinical and angiographic outcomes at discharge and follow-up were retrospectively evaluated.

RESULTS: One hundred sixty-seven patients (male/female ratio, 30:137; mean age, 58 years) with multiple aneurysms (418 aneurysms; mean, 2.5 aneurysms/patient) underwent attempted 1-stage coiling for ≥2 aneurysms (359 aneurysms; mean, 2.1 aneurysms/patient). In 131 patients (78.4%), all detected aneurysms were treated with coiling only. Treatment-related morbidity and mortality at discharge were 1.8% and 0.6% per patient, respectively. Of the 132 patients without subarachnoid hemorrhage, 129 (97.7%) had favorable outcomes (mRS 0–2) at discharge; of the 35 patients with SAH, 27 (77.1%) had favorable outcomes at discharge. Of the 162 patients (97%) for whom clinical follow-up was available (mean, 35.8 months), 154 patients (95.1%) had favorable outcomes. Immediate posttreatment angiography showed complete occlusion in 186 (51.8%) aneurysms, neck remnants in 134 (37.3%), sac remnants in 33 (9.2%), and failure in 6 (1.7%). Of the 262 (73.9%) aneurysms that underwent follow-up imaging (mean, 24.8 months), 244 (93.1%) showed a stable or improved state, with 12 (4.6%) minor and 6 (2.3%) major recurrences.

CONCLUSIONS: One-stage coiling of multiple aneurysms seems to be safe and effective, with low morbidity and mortality.

Intracranial aneurysm is the most important cause of subarachnoid hemorrhage, resulting in 8%–20% dependent morbidity and 37%–57% mortality.1 Strategies and methods for treating intracranial aneurysms have been extensively studied. Multiple intracranial aneurysms are frequent, with a reported incidence of 19%–34% of patients who present with SAH.2⇓⇓–5 Determining treatment strategy and methods for multiple aneurysms is often complicated. Coiling is currently accepted as a standard treatment for ruptured or unruptured intracranial aneurysms and has been increasingly used, regardless of the location of the intracranial aneurysm.6 Nevertheless, while many cases of clipping for multiple aneurysms have been reported,7⇓⇓⇓⇓–12 there were only 2 small case series using coiling for multiple aneurysms.13,14 The purpose of this study was to evaluate the safety and effectiveness of 1-stage coiling for multiple intracranial aneurysms.