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Late reopening of adequately coiled intracrani al aneurysms frequency and risk factors in 400 patients with 440 aneury

Late reopening of adequately coiled intracrani al aneurysms frequency and risk factors in 400 patients with 440 aneurysms. Sandra Ferns, on behalf of the LOTUS study group. Depts of Neurosurgery and Radiology, AMC Amsterdam Depts of Neurology and Radiology, UMC Utrecht

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Late reopening of adequately coiled intracrani al aneurysms frequency and risk factors in 400 patients with 440 aneury

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  1. Late reopening of adequately coiled intracranial aneurysmsfrequency and risk factors in 400 patients with 440 aneurysms Sandra Ferns, on behalf of the LOTUS study group Depts of Neurosurgery and Radiology, AMC Amsterdam Depts of Neurology and Radiology, UMC Utrecht Dept of Radiology, St. Elisabeth Ziekenhuis, Tilburg Dept of Neurosurgery, Slotervaart Ziekenhuis Amsterdam Depts of Neurosurgery and Radiology, Leiden UMC Depts of Neurosurgery and Radiology, VUMC Amsterdam Depts of Neurology and Radiology, Maastricht UMC All in the Netherlands

  2. Background • Risk reopening1,2 • Information on ‘late’ (>6 mo) reopening sparse Purpose: • To determine frequency of late reopening and possible risk factors 1; Molyneux et al Lancet 2002, 2; Raymond et al, Stroke 2003

  3. Aneurysm occlusion3 complete neck incomplete remnant 3; Raymond et al, J neurosurg 1997

  4. Methods LOTUS STUDY • Design: multicenter prospective follow-up study • 7 Dutch participating centers with MEC approval • AMC, Amsterdam • UMC, Utrecht • St Elisabeth ZH, Tilburg • VUMC, Amsterdam • LUMC, Leiden • Slotervaart ZH, Amsterdam • MUMC, Maastricht

  5. Methods PATIENTS • Inclusion criteria: • age 18-70 • coiling >4.5 years ago • GOS 4/5 • adequate aneurysm occlusion after 6 months • no contra-indications for MRA at 3Tesla • 400 patients

  6. Methods IMAGING • 3 Tesla MRI, Philips Medical Systems • T2 weighted imaging • MOTSA 3D TOF • Standard MIP and VR 3D reconstructions EVALUATION • 2 observers • Suspected incomplete occlusion: compare to initial and 6 month angiography

  7. Methods ANALYSES • Proportion reopening, retreatment • Risk factors for late reopening • gender • rupture status • size ≥ 10 mm • posterior circulation • basilar tip

  8. Results patients 400 participants younger than 571 non-participants (mean 55 versus 57 yrs, p<0.001) 16% Participation 74% mean follow-up 6.0 years (median 5.0, range 4.5-12.9 yrs)

  9. Results late reopening • Agreement 421/440 aneurysms; 95.7% • Reopening: • 11/400 patients (2.8%, 95%CI 1.4-4.9%) • with 440 aneurysms (2.5%, 95%CI 1.0-4.0%) • Retreatment: • 3/440 aneurysms (0.7%, 95%CI 0.2-1.5%)

  10. Results risk factors • Aneurysm size ≥ 10 mm • (OR 5.2, 95% CI 1.3-16.3, p=0.01) • Location basilar artery tip • (OR 3.9, 95% CI 1.1- 14.6, p=0.04).

  11. 3 CASES(Late reopening after adequate coiling at 6 month FU angiography)

  12. 1. 49 year-old woman Ruptured basilar tip aneurysm 12 mm Directly after coiling 7 m FU 25-8-04

  13. 1. 49 year-old woman Ruptured basilar tip aneurysm 12 mm 4.7 yrs FU VR Not retreated Unfavorable morphology 4.7 yrs FU MRA reopening 3x8 mm

  14. 2. 27 year-old woman Unruptured additional left carotid tip aneurysm 6 mm Before embolisation 5 months FU

  15. 2. 27 year-old woman Unruptured additional left carotid tip aneurysm 6 mm 4.5 yrs FU Reopening 3x3 mm 4.5 yrs FU VR After retreatment 4.5 yrs FU DSA

  16. 3. ♀, 42 year-old woman Ruptured left PcomA aneurysm 5 mm Before coiling Directly after coiling 6 month FU

  17. 3. ♀, 42 year-old woman Ruptured left PcomA aneurysm 5 mm 4.9 yrs FU MRA reopening 4x3mm No retreatment Patient refusal

  18. Conclusion • Yield of long-term (mean 6 years) follow-up MRA of coiled aneurysms with adequate occlusion at 6 month follow-up angiography is low • Proportion reopening: 2.5% (11/ 440) • Retreatment: 0.7% (3/ 440)

  19. AMC S.P. Ferns, PhD student C.B.L.M. Majoie, radiologist (Principle investigator) R. van den Berg, radiologist M.E.S. Sprengers, radiologist J.C. van Rijn, radiologist J.J. Schneiders, PhD student P.M. Bossuyt, clinical epidemiologist W.P. Vandertop, neurosurgeon B.A. Coert, neurosurgeon St. Elizabeth Ziekenhuis Tilburg W.J.J. van Rooij, radiologist M. Sluzewski, radiologist Slotervaart Ziekenhuis B.J.C.M. Hummelink, neurosurgeon LOTUS study group • UMCU • G.J.E. Rinkel, neurologist • B.K. Velthuis, radiologist • G.A.P. de Kort, radiologist • J.D. Schaafsma, neurologist resident • VUMC • F. Barkhof, radiologist • J.C.J. Bot, radiologist • LUMC • P.A. Brouwer, radiologist • M.A. van Walderveen, radiologist • MUMC • W.H. van Zwam, radiologist • R. van Oostenbrugge, neurologist

  20. Results: late reopening * Retreatment not judged indicated by multidisciplinary team; † Patient not retreated because of co-morbidity ‡ Patient not retreated because of unfavorable morphology of the aneurysm remnant; § Patient refused retreatment

  21. Results: risk factors reopening

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