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De Novo Intracranial Aneurysms Detected on Imaging Follow-Up of Coiled Aneurysms in a Korean Population

Korean Journal of Radiology 2019년 20권 9호 p.1390 ~ 1398
 ( Yeon Eung-Koo ) - Kyung Hee University School of Medicine Kyung Hee University Medical Center Department of Radiology

 ( Cho Young-Dae ) - Seoul National University College of Medicine Seoul National University Hospital Department of Radiology
 ( Yoo Dong-Hyun ) - Seoul National University College of Medicine Seoul National University Hospital Department of Radiology
 ( Lee Su-Hwan ) - Dongguk University College of Medicine Dongguk University Ilsan Hospital Department of Neurosurgery
 ( Kang Hyun-Seung ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
 ( Cho Won-Sang ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
 ( Kim Jeong-Eun ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
 ( Han Moon-Hee ) - Veterans Health Service Medical Center Department of Radiology

Abstract


Objective: Coiled aneurysms are known to recanalize over time, making follow-up evaluations mandatory. Although de novo intracranial aneurysms (DNIAs) are occasionally detected during routine patient monitoring, such events have not been thoroughly investigated to date. Herein, we generated estimates of DNIA development during long-term observation of coiled cerebral aneurysms, focusing on incidence and the risk factors involved.

Materials and Methods: In total, 773 patients undergoing coil embolization of intracranial aneurysms between 2008 and 2010 were reviewed retrospectively. Their medical records and radiologic data accrued over the extended period (mean, 52.7 ± 29.7 months) were analyzed. For the detection of DNIA, follow-up magnetic resonance angiography and/or conventional angiography were used. The incidence of DNIAs and related risk factors were analyzed using Cox proportional hazards regression and Kaplan-Meier product-limit estimator.

Results: In 19 (2.5%) of the 773 patients with coiled aneurysms, DNIAs (0.56% per patient-year) developed during continued long-term monitoring (3395.3 patient-years). Of these, 9 DNIAs (47.4%) were detected within 60 months, with 10 (52.6%) emerging thereafter. The most common site involved was the posterior communicating artery (n = 6), followed by the middle cerebral artery (n = 5) and the basilar top (n = 4). Multivariate analysis indicated that younger age (< 50 years) (hazard ratio [HR] = 1.045; p = 0.010) and recanalization of coiled aneurysms (HR = 2.560; p = 0.047) were significant factors in DNIA formation, whereas female sex, smoking, and hypertension fell short of statistical significance. Cumulative survival rates without DNIA were significantly higher in older subjects (> 60 years; p < 0.001) and in the absence of post-coiling aneurysm recurrence (p = 0.006).

Conclusion: In most patients with coiled aneurysms, development of DNIAs during long-term monitoring is rare. However, younger patients (< 50 years) or patients with recurring aneurysms appear to be predisposed to DNIAs.

키워드

Aneurysm; Follow up; De novo; Coil embolization
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