Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding

Object. During a 5-year period 317 patients presenting with aneurysmal suba rachnoid hemorrhage were successfully heated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term. efficacy in protecting patients against rebleeding, Methods. Patients were followed for 6 to 65 months (median 22.3 months) by clinical review, angiography performed at 6 months posttreatment, and annua l questionnaires. Stable angiographic occlusion was evident in 86.4% of sma ll and 85.2% of large aneurysms with recurrent filling in 38 (14.7%) of 259 aneurysms. Rebleeding was caused by aneurysm recurrence in four patients ( between 11 and 35 months posttreatment) and by rupture of a coincidental un treated aneurysm in one patient. Annual rebleeding rates were 0.8% in the 1 st year, 0.6% in the 2nd year, and 2.4% in the 3rd year after aneurysm embo lization, with no rebleeding in Subsequent years. Rebleeding occurred in th ree (7.9%) of 38 recurrent aneurysms and in one (0.4%) of 221 aneurysms tha t appeared stable on angiography. Conclusions. Periodic follow-up angiography after coil embolization is reco mmended to identify aneurysm recurrence and those patients at a high risk o f late rebleeding.